Where did the ASP come from?

Effective Nov. 28, 2017, all Medicare and Medicaid-certified nursing homes must have an antibiotic stewardship program that includes antibiotic-use protocols and a system to monitor antibiotic use as part of their infection prevention and control program (IPCP), according to §483.80 (Infection Control) of the Code of Federal Regulations. The antibiotic stewardship program is a component of the Phase 2 rollout of the Reform of Requirements for Long-term Care Facilities, and surveyors will assess compliance with this new requirement of participation under F-tag 881 (ASP) during the Infection Control Facility Task that is a mandatory part of the new survey process.  

Is the ASP in effect now?

Yes, it went into effect on Nov. 28, 2017 but CMS has given an 18-month enforcement moratorium to all SNFs for several of the F-tags associated with the Phase 2. This includes F-Tag 881 for Antibiotic Stewardship. This mean they need to the best of their abilities to follow the ASP but when the State does their annual survey they will not be penalized at this point.

What is the purpose of the ASP?

Antimicrobial stewardship is a coordinated program with CMS and each individual state that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms. In a nutshell; reduce the use of antibiotics in SNFs to prevent creation of superbugs.  

“…a set of commitments and actions designed to optimize the treatment of infections while reducing the adverse events associated with antibiotic use.”

-Centers for Disease Control and Prevention 

How will this be done at the SNF level?

• Leadership Support
• Accountability
• Drug Expertise
• Policies to support optimal Antibiotic use
• Tracking: Monitoring antibiotic prescribing, use and resistance
• Reporting information to staff on improving use and resistance
• Education 

Who serves on the committee for the SNF?

1. Medical Director
2. At least 1 attending prescriber
3. Housekeeping
4. Director of Nursing (DON)
5. Dietary Services
6. Pharmacist
7. Executive Director
8. Laboratory personnel

How Often do they need to meet and communicate?

Once a month for the operational staff, Quarterly for the Medical Director. Communications need to be distributed monthly to all members and in person to operational members.

What are the penalties if SNFs do not meet these standards?

There will be combination of the following; civil money penalties, payment denials for new admissions, or termination of their Medicare certification. Failure to comply will also affect their Star rating.

What is the 5 Star Rating for SNF?

CMS created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about which you may want to ask questions. The ratings are based on the State Surveys for Health Inspections, Staffing and Quality Measures (QMs). A drop in Star Rating can have a great financial impact just as an increase in the Star Rating can increase profitability.  

Are most Skilled Nursing Facilities prepared for the ASP?    

NO!!!! They are looking for a Champion to come in and show them the best way to meet the regulations while not putting more of a burden on the existing staff. 

What Solution can Volente Healthcare provide?

Program vs Product – Yes, Volente is Diagnostic Laboratory but when it comes to Antibiotic Stewardship we are Volente Healthcare which has a packaged solution to ASP. There are several aspects the SNFs are looking for when they think about ASP; Education, Clinical, Pharmacy, Reporting, Staffing, Compliance and Cost. The Volente Healthcare program for ASP will address each of these issues.

How does the Volente Healthcare ASP Program solve these issues?

1. Education – The Volente website will provide multiple Continuing Education modules on Antibiotic Stewardship. These certified CE courses will not only provide the needed education required for ASP they will also provide needed CE credits for the facilities medical staff. These courses have been reviewed by the Volente medical and pharmaceutical staff to assure they cover the most important aspects of the ASP.
2. Clinical – The main issue that first needs to be addressed with ASP is does the patient have a Bacterial or Viral infection. By using the Volente; Gastro Dx, UTI Dx, Wound Dx, and Respi Dx clinically it can be determined if they have a bacterial or viral infection. To those patients which have a repeated bacterial infection or issues with their antibiotics the Volente Antibiotic Resistance Dx panel can determine the best medication therapy for them.
3. Pharmacy – The Volente staff of pharmacists have been certified and trained to properly read all of the Volente test panels to help determine the best medication outcome for the facilities residents. The pharmacist will then work with the facilities pharmacy to create the needed medication management to eradicate the Bactria while assuring the use of the proper Antibiotic based on the patient’s DNA.
4. Reporting – Working together the Volente medical and IT staff have created the needed monthly reports that the state surveyors will be reviewing to see that the ASP standards have been met. These reports can quickly be reviewed by the ASP Committee members for them to sign off on each month.
5. Staffing – The ASP protocols are asking for the SNFs to have one ID champion on staff to oversee the program. Volente will provide staff members to allow them access to experts in the operational, medical and pharmaceutical fields that can provide the needed knowledge for this position to find all their answers at one source.
6. Compliance – By assisting with the Educational, Clinical, Pharmacy, Reporting and Staffing needs Volente will help assure that each SNFs is in compliance with the ASP standards for their annual survey.
7. Cost- Beyond the cost of the patients testing needs there are no additional costs associated with the Volente Healthcare ASP Program. 

You can contact Volente direct by going to their website www.volentedx.com