Role of JCAHO standards and clinical practice guidelines in promoting appropriate antimicrobial use

The role of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards and clinical practice guidelines in promoting appropriate antimicrobial use and the development of such standards and guidelines are described. JCAHO is committed to continuously improve the safety and quality of patient care. Reducing antimicrobial resistance in health systems often requires change, something that many health care practitioners are reluctant to embrace. Current JCAHO standards suggest that the use of clinical practice guidelines be considered, but guideline use is not required. JCAHO's standards development process is lengthy and involved. Therefore, it is easier to effect change by modifying the statements of intent that accompany the standards than the standards themselves. Concerns about antimicrobial resistance can be addressed through performance measurement. In July 2002, core measures of patient care processes and outcomes will be implemented for the first time. JCAHO requires hospital laboratories to be accredited, which increases the stature of the laboratory in the eyes of hospital administration. JCAHO laboratory standards directly relate to clinical practice guidelines, antimicrobial resistance, and NCCLS (formerly known as the National Committee for Clinical Laboratory Standards) and support efforts to reduce inappropriate antimicrobial use. Hospital laboratories play a vital role in effecting change in antimicrobial use. JCAHO laboratory standards for clinical practice guidelines and quality control support efforts to reduce inappropriate antimicrobial use. Hospitals have been reluctant to require the use of clinical practice guidelines in JCAHO standards, although guidelines promote appropriate antimicrobial use and reduce antimicrobial resistance. Pharmacists should work with laboratory staff and JCAHO to effect the changes needed to stem antimicrobial resistance.