Antibiotic Stewardship

According to the Centers for Disease Control and Prevention (CDC), antibiotic stewardship is both a commitment and action for judicious use of antibiotics to optimize treatment of infections while reducing the risk of adverse reactions.  The CDC has provided core elements of antibiotic stewardship in nursing homes which include: leadership commitment, accountability, drug expertise, action, tracking, reporting, and education.  In an effort to protect nursing home residents now and in the future, a large Midwestern long-term care facility implemented an antibiotic stewardship program in 2017.  The facility first formed an interprofessional team.  Members involved included: a Doctor of Nursing Practice graduate student, the facility medical director, director and assistant directors of nursing, and the infection prevention nurse who collects and analyzes infection surveillance data.  Technical assistance was provided by the nurse IT support specialist and administrative assistant.  Also, expert advice and consultation was provided by two retired Infectious Disease physician specialists, a consultant pharmacist, a quality improvement specialist, and a Minnesota Department of Health antibiotic stewardship leader.  This team has, and continues to meet monthly to review data, evaluate current stewardship activities, and promote future activities.

A series of actions have been carried out as part of the facility’s antibiotic stewardship program, with the primary focus on urinary tract infection. These include:

·         Development of an antibiotic stewardship dashboard with key performance metrics such as: UTI rates, antibiotic use for facility acquired suspected urinary tract infections (UTIs), documentation of UTI criteria, UA/UC orders and results

·         Staff education on the importance of antibiotic stewardship, methods to utilize algorithm-based assessment measures of a suspected UTI, prevention strategies for a UTI, and SBAR communication methods to notify the provider regarding change in condition for suspected UTI.

·         Built within the electronic health record, a standardized nurse assessment communication and documentation tool to facilitate effective nurse to provider communication regarding suspected UTIs in residents https://www.ahrq.gov/sites/default/files/wysiwyg/nhguide/4_TK1_T1-SBAR_UTI_Final.pdf

·         Obtained a facility specific antibiogram for E.Coli urinary isolates from the contracted facility laboratory.

·         Developed a facility policy on antibiotic stewardship for long-term care. A similar policy could be modified from this version: http://www.health.state.mn.us/onehealthabx/ltcsamplepolicy.pdf

Continued and future work includes:

·         Providing individual provider feedback on antibiotic prescription practices.

·         Developing and implementing a guideline for diagnosis and management of UTIs.

·         Continuing education for nurses on antibiotic stewardship efforts and use of the communication and documentation tool.

·         Increasing resident and family awareness of antibiotic stewardship through posted signs, handouts, and inserts in admission packets http://www.health.state.mn.us/divs/idepc/dtopics/antibioticresistance/asp/ltc/index.html; https://www.cdc.gov/antibiotic-use/community/materials-references/print-materials/adults/index.html

·         Similar feedback forms and guidelines could be modified from the attached versions 

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MAGIC 's TOPICS publication has a full summary.
Nursing Home Antibiotic Stewardship to Address Asymptomatic Bacteriuria and Urinary Tract Infection: A Quality Improvement Project