The Centers for Medicare and Medicaid Services requires nursing homes to establish and maintain an antibiotic stewardship program as a part of their infection prevention and control program. The antibiotic stewardship program should includes antibiotic use protocols and a system to monitor antibiotic use [§483.80(a)(3) – effective November 28, 2017 (Phase 2)]
Improving the use of antibiotics in healthcare to protect patients and reduce the threat of antibiotic resistance is a national priority. Per the CDC, Antibiotic Stewardship refers to a set of commitments and actions designed to “optimize the treatment of infections while reducing the adverse events associated with antibiotic use.” The Centers for Disease Control and Prevention (CDC) recommends that all acute care hospitals as well as all nursing homes and assisted living facilities (Long-Term Care facilities) implement an antibiotic stewardship program (ASP) to improve antibiotic prescribing practices and reduce inappropriate use.
According to the Centers for Medicare and Medicaid Services, antibiotics are among the most frequently prescribed medications in nursing homes, with up to 70% of residents in a nursing home receiving one or more courses of systemic antibiotics when followed over a year. Similar to the findings in hospitals, studies have shown that 40–75% of antibiotics prescribed in nursing homes may be unnecessary or inappropriate.
Harms from antibiotic overuse are significant for the frail and older adults receiving care in nursing homes and include risk of serious diarrheal infections from Clostridium difficile, increased adverse drug events and drug interactions, and colonization and/or infection with antibiotic-resistant organisms.
The Core Elements of Antibiotic Stewardship for Nursing Homes adapts the CDC Core Elements of Hospital Antibiotic Stewardship into practical ways to initiate or expand antibiotic stewardship activities in nursing homes. Core Elements for Antibiotic Stewardship in Nursing Homes are as follows: Leadership Commitment, Accountability, Drug Expertise, Action, Tracking, Reporting, and Education. Nursing homes are encouraged to work in a step-wise fashion, implementing one or two activities to start and gradually adding new strategies from each element over time.
Staff (nursing and clinical providers) education is one of the core elements of a comprehensive antibiotic stewardship program. Education addressing the organization’s antibiotic stewardship program should be provided at the time of hire and as needed. There are a variety of mechanisms for disseminating antibiotic stewardship education to staff including flyers, pocket-guides, newsletters or electronic communications; however, interactive academic detailing (e.g., face-to-face interactive workshops) has the strongest evidence for improving medication prescribing practices.
Any action taken to improve antibiotic use is expected to reduce adverse events, prevent emergence of resistance, and lead to better outcomes for residents in this setting.
Case Studies:
- One nursing home antibiotic stewardship intervention demonstrated a sustained reduction in antibiotic use for two years after the intervention by linking education with feedback on physician prescribing practices. (CDC, 2015)
- Another study showed a 64% reduction in inappropriate antibiotic use (i.e., prescriptions which did not adhere to guidelines), by providing feedback on individual physician prescribing practices and adherence to the guidelines over 12 months. (CDC, 2015)
- Studies show that use of an antibiogram in nursing homes can decrease antibiotic prescribing. (AHRQ, June 2012)
Tools:
The Core Elements of Antibiotic Stewardship for Nursing Homes
The Core Elements of Antibiotic Stewardship for Nursing Homes Checklist
Policy and Practice Actions to Improve Antibiotic Use
Measures of Antibiotic Prescribing Use and Outcomes
MCN Healthcare Products:
Long Term Care Policy and Procedure Manual
Long Term Care Environment of Care Manual
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