Antibiotic Stewardship – Entry 2

Dear Diary:

Today our Antibiotic Stewardship workgroup got together to discuss the first two antibiotic stewardship core elements: Leadership Commitment and Accountability. Using an example Antibiotic Stewardship Program Policy was helpful in guiding our work. We first defined the rationale for developing an antibiotic stewardship program. This is what we came up with:

The purpose of River View Rehabilitation and Care Center’s antibiotic stewardship program is to optimize clinical outcomes and the appropriate use of antibiotics for our residents. Our stewardship program will ensure the optimal selection, dose, and duration of antibiotics that lead to the best clinical outcome for the treatment of resident infections while limiting side effects and the risk for subsequent resistance.

We will share this statement with all staff, as well as our residents and families. We’re updating my job description and the job descriptions of the medical director, consultant pharmacist, and infection prevention program coordinator to include antibiotic stewardship duties. Antibiotic stewardship is now on the agenda of our next QAPI committee meeting. The workgroup will report regularly on our effort and outcomes.

The accountability core element work was next. We agreed on these responsibilities for each role:

  • Medical Director: set standards for antibiotic prescribing practices for all clinical providers, review antibiotic use data, and ensure best practices are followed for all residents in the facility
  • Nursing Director: set nursing staff practice standards, or protocols, for assessing, monitoring, and communicating changes in a resident’s condition and ensure these practice standards are followed
  • Consultant Pharmacist: conduct medication regimen review, participate in ongoing QAPI committee, and report antibiotic use data
  • Infection Preventionist: track antibiotic starts, monitor adherence to evidence-based published criteria during the evaluation and management of treated infections, and review antibiotic resistance patterns in the facility to understand which infections are caused by resistant organisms
  • Laboratory: develop a process to alert nursing staff if antibiotic-resistant organisms are identified, provide education for staff on the difference in diagnostic tests available for detecting various infectious pathogens, create a summary report of antibiotic susceptibility patterns from organisms isolated in cultures (antibiograms), and monitor for new or worsening antibiotic resistance

Members of our workgroup agreed to spend time before our next meeting getting more familiar with each of our responsibilities. I’m sure we’ll have more discussion.

Signed, Donna

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