Antibiotic Stewardship for Nursing Homes
by Frank Randolph, MD, CMD
CALTCM BOD Member & Past President
 

On September 18th the American Geriatric Society’s Week in Review publication called attention to the need to improve prescribing practices to reduce treatment-resistant infections by spotlighting a resource from the Center for Disease Control and Prevention, “Core Elements of Antibiotic Stewardship for Nursing Homes."

This resource points out that up to 70% of residents in a nursing home receive one or more courses of systemic antibiotics when followed over a year.  Studies reveal that 40–75% of antibiotics prescribed in nursing homes may be unnecessary or inappropriate.  The down side for often frail elders includes risk of major diarrheal infections from Clostridium difficile, adverse drug events and drug interactions, and colonization and/or infection with antibiotic-resistant organisms.

The resource suggests practical strategies to initiate or expand antibiotic stewardship activities in nursing homes, likely to reduce adverse events, prevent emergence of resistance, and lead to better outcomes for residents in nursing homes. Recommendations include leadership commitment to safe and appropriate antibiotic use, empowering the director of nursing and medical director to set standards and engaging the consultant pharmacist in quality assurance actions such as medication regimen review and reporting antibiotic use data. Getting help to support antibiotic stewardship efforts from partners such as an infection prevention program coordinator, a consultant laboratory, or the public health department is encouraged.   Developing and promoting prescribing policies is suggested-examples include requiring dose, duration, and indication for all antibiotic prescriptions or use of facility-specific algorithm for appropriate diagnostic testing (e.g., obtaining cultures) for specific infections.   Tracking and reporting antibiotic use and outcomes and sharing such data with clinicians and nurses to maintain awareness about the progress being made in antibiotic stewardship is key.  Download the document to find more useful strategies, examples of educational materials, and samples of prescribing policies which make this resource worth reading.

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