When beginning an Antibiotic Stewardship in Your Facility you will want to first look at the Core Elements of Antibiotic Stewardship for Nursing Homes as defined by the CDC. “Improving the use of antibiotics in healthcare to protect patients and reduce the threat of antibiotic resistance is a national priority.

Antibiotic Stewardship

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 implement an antibiotic stewardship program (ASP) and outlined the seven core elements which are necessary for implementing successful ASPs. CDC also recommends that all nursing homes take steps to improve antibiotic prescribing practices and reduce inappropriate use.

1. Leadership Commitment - This is a multi-faceted approach. The leadership in the facility needs to commit to decreasing unnecessary antibiotic use in the facility. The leadership then needs to share this with the facility staff. This can be done in many ways:
• Writing a statement to share with staff
• Including stewardship-related duties in position description
• Communicating facility expectations with staff
• Creating a facility culture and celebrating improvement
2. Accountability - Identify the individuals that have the support of the facility:
• Medical Director will set standards for antibiotic prescribing practices
• Director of Nursing will set the standards for assessments and monitoring
• Consulting Pharmacist will provide antibiotic review and reporting through the QA process
3. Drug Expertise - This can be accomplished by having access to infectious disease consultants and/or consultant pharmacist with a background in the antibiotic stewardship program.
4. Take Action Through Policy and Practice Change - The facility should implement policies and procedures to improve antibiotic use:
• Policies that support optimal antibiotic use including medication safety policies and medication regimen reviews
• Broad interventions to improve antibiotic use will help to standardize the practices that will be used if a resident suspected of an infection is initially placed on antibiotic therapy
• Pharmacy interventions to improve antibiotic use
• Include the dispensing and/or consultant pharmacists into the clinical care team
• Infection- and syndrome-specific interventions to improve antibiotic use
• Identify clinical situations which may be driving inappropriate courses of antibiotics such as asymptomatic bacteriuria or urinary tract infection prophylaxis and implement specific interventions to improve use.
5. Tracking Antibiotic Use and Outcomes - The tracking should include antibiotic use practices as well as outcomes related to antibiotics:
• Tracking how and why antibiotics are prescribed
• Tracking how often and how many antibiotics are prescribed
• Tracking the adverse outcomes and costs from antibiotics
6. Reporting on Antibiotic Use and Outcomes - Reports should be prepared using the tracked data and presented to doctors, nurses and relevant staff.
7. Education - Educate on the Antibiotic Stewardship Program process and goals:
• Clinicians
• Nursing staff
• Residents
• Families

Including these core elements in Antibiotic Stewardship Program will allow the facility to start a few activities and slowly expand the activities over time.

The CDC has developed some great resources to help facilities start their own Antibiotic Stewardship Program. For more information visit the CDC website. If you still have questions, please don’t hesitate to contact us at Richter Healthcare Consultants.