DNV GL Advisory Modifies Interpretive Guidance for MM.8, Antimicrobial Stewardship

PUBLISHED: Feb 28, 2019
Relevant to: Hospitals

DNV GL has issued an advisory for for NIAHO® Accredited Organizations to clarify the survey of antimicrobial stewardship. NIAHO® Accreditation Requirements, Interpretive Guidelines and Surveyor Guidance, Revision 18-2, was submitted to CMS for approval in June 2018. CMS approved the revision in the 4th quarter of 2018.

In the months between the time the NIAHO Accreditation Requirements were submitted and when they were approved by CMS, DNV GL was made aware of a shift in focus from the U.S. Centers for Disease Control and Prevention (CDC). Revision 18-2 includes the following requirement for antibiotic review:

  • MM.8, SR.5: The hospital has a formal procedure for all practitioners to review the appropriateness of any antibiotics prescribed after 48 hours from the initial orders (e.g., antibiotic time-out).

According to DNV GL, the CDC has shared new research indicating that the antibiotic time-out alone is not likely to have much impact on antibiotic use. As a result, CDC is shifting emphasis from the antibiotic time-out to two other specific interventions that have demonstrated benefit in published studies:

  • Post-prescription review of antibiotic selection with feedback
  • Prior authorization of antibiotics

CMS has made recommendations regarding antimicrobial stewardship but has not elevated these recommendations to a Condition of Participation at this time. DNV GL elected to include antimicrobial stewardship requirements as part of our participation in the CDC AMR Challenge (See Advisory Notice 2019-HC05). Because the CDC emphasis has evolved, DNV GL wanted to share the most current evidence-based practice with their customers.

DNV GL has indicated that they will make appropriate revisions in Revision 19-0 to reflect the CDC recommendations. In the interim, DNV GL surveyors will not cite a nonconformance to MM.8, SR.5 as a finding.

While hospitals are not discouraged by DNV GL from following an antibiotic time-out procedure if desired, DNV GL is encouraging hospitals to consider post-prescription review of antibiotic selection, with feedback, as well as prior authorization of antibiotics in the implementation of their antimicrobial stewardship programs.

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