How to become an antimicrobial stewardship pharmacist

"If I didn't do a PGY2 residency in infectious disease; can I still be the antimicrobial stewardship program pharmacist?" This is a question asked by many smaller hospital pharmacy departments with limited staff, or team members who lack formal infectious disease training. The Presidential Executive Order 13676: Combatting Antibiotic Resistance Bacteria released in September 2014, the President’s Council of Advisors on Science and Technology (PCAST) report, and the subsequent National Action Plan for Combating Antibiotic-Resistant Bacteria called for a national mandate for acute care settings to establish an antimicrobial stewardship program (ASP) as part of the Conditions of Participation (COP) from Centers for Medicare and Medicaid Service (CMS).The National Action Plan explicitly states that the ASP should be in compliance with recommendations from the Centers for Disease Control and Prevention’s (CDC) Core Elements of Hospital Antibiotic Stewardship Programs.1 Furthermore, antimicrobial stewardship program is now a part of the Joint Commission Medication Management standard.²

Since the announcement of this national mandate, hospitals and healthcare providers are experiencing a sense of urgency to implement an ASP at their facilities in anticipation of the COP requirement. The CDC’s core elements document outlines recommendations on developing an institutional ASP. It states that the core members for antimicrobial stewardship program should appoint physicians and pharmacists as co-leaders responsible for the program management and outcomes. Pharmacy expertise is a key core element to ensure successful implementation efforts to improve antimicrobial use.¹

One of the biggest challenges that smaller hospitals may face is having clinicians with formal infectious diseases (ID) training. While literature demonstrates that formal training in ID can benefit stewardship program leaders, formal ID training is not a requirement for ASP core members. For example, a hospitalist can often be ideal physician leader due to their expertise in patient care and commitment to quality improvement. ³

The American Society of Health-System Pharmacists (ASHP) released a statement on the role of pharmacists in ASP in 2010.⁴ Pharmacists are expected to:

• Collaborate with multidisciplinary team to ensure appropriate antibiotic use to optimize patient outcomes
• Develop restricted antimicrobial-use procedures, therapeutic interchange, treatment guidelines and clinical care pathways
• Collaborate with Pharmacy and Therapeutics (P&T) committee to maintain an appropriate antibiotic formulary based on the patient population served
• Generate and analyze antimicrobial use related metrics
• Work with microbiology personnel to ensure appropriate microbial susceptibility tests
• Provide education and information on ASP via clinical conferences, newsletters, in-services for healthcare professionals on topics such as antimicrobial use and resistance.⁵

ASHP recognizes the shortage of formal PGY2 ID residency positions and suggests that pharmacists without formal training may have to acquire antimicrobial stewardship responsibilities. In contrast, Ernst et al., along with Society of Infectious Disease Pharmacists (SIDP) and American College of Clinical Pharmacists (ACCP) provide recommendation on the training and certification for pharmacists practicing in ID pharmacotherapy. Ernst recommends a future ID-trained pharmacist to attain a PGY1 residency and a PGY2 residency in ID. No recommendations were made to establish training requirements for pharmacists with extensive on-the-job training in ID. ⁶

However, since 2018, infectious diseases is recognized by the Board of Pharmacy Specialties.7 Eligibility for sitting for the board exam include:

• Completion of a PGY-2 Infectious Diseases specialty residency
• Completion of a PGY-1 Pharmacy residency plus 2 additional years of practice experience, with 50% of more of that time spent in the area of infectious diseases as defined in the exam content outline
• Four years of practice experience, with 50% of more of that time spent in the area of infectious diseases as defined in the exam content outline

Pharmacists with experience in the area of infectious diseases who had not trained formally through a PGY-2 residency may obtain the board certification in infectious diseases (BCIDP) as outlined above to be formally recognized for the mastery of domain expertise. For pharmacist without such practice experience, there are certificate programs for pharmacists looking for ID training. SIDP and Making-a-Difference in Infectious Diseases Pharmacotherapy (MAD-ID) provide such certificate training programs.

The SIDP program composed of three components including an independent internet learning didactic, live webinars that are offered quarterly, and finally, a practical skill component (project-based) at practice site.MAD-ID offers two programs: a basic program that focuses on the basic skills and overview of ASP, and an advanced program designed for pharmacists and physicians that have some antimicrobial stewardship experience. The basic program is structured similarly to the SIDP program while the advanced program entails a didactic component that requires traveling to MAD-ID’s annual conference and a practical skill component at gained at a practice site.

To become a pharmacy leader as part of ASP, you do not need formal PGY1 and PGY2 residency training in ID. However, you will need to be an agent of change and be passionate about improving antibiotic usage and patient outcomes. If you had extensive on-the-job training and experience, successfully obtaining board certification demonstrates your mastery of infectious diseases pharmacotherapy.  If you are just starting out and are interested in becoming a change agent to decrease antibiotic resistance, I would strongly recommend you to enroll in the SIDP or MAD-ID certificate programs. You may contact your human resource department to find out if the certificate training program would qualify for tuition or professional training reimbursement at your organization.

For more information on SIDP and/or MAD-ID certificate programs:

• SIDP: http://s3.proce.com/res/pdf/SIDP-ASP_Announcement.pdf
• MAD-ID: http://mad-id.org/antimicrobial-stewardship-programs/