Our Antibiotic Stewardship workgroup met today to work on two more antibiotic stewardship core elements: Drug Expertise and Take Action through Policy and Practice Change to Improve Antibiotic Use. I feel so fortunate that Ron, our consultant pharmacist, is excited about this work and has eagerly taken on the drug expertise core element. As outlined in the example Antibiotic Stewardship Program Policy, we agreed on the following:
- Our pharmacy consultant will review and report antibiotic usage data to the QAPI committee every month.
- Dr. Amery, our medical director, has a great working relationship with Dr. Clemens, an infectious disease physician who practices in our community. Any questions that Dr. Amery can’t answer will be referred to Dr. Clemens.
The next thing we talked about was taking action and implementing policy and practice actions to improve antibiotic use. Dr. Amery agreed to begin drafting these protocols, which will include:
- Improving the evaluation and communication of clinical signs and symptoms when a resident is first suspected of having an infection.
- Defining and optimizing the use of diagnostic testing.
- An antibiotic review process known as “antibiotic time-out” (ATO) for all antibiotics prescribed in the facility. ATOs prompt clinicians to reassess the ongoing need for and choice of an antibiotic when the clinical picture is clearer and more information available.
- A method of flagging residents with multidrug-resistant organisms (MDROs) instituted by the laboratory (we need to reach out to our consultant laboratory to see if they can do this for us).
I reminded Dr. Amery of a great resource found in the Core Elements of Antibiotic Stewardship for Nursing Homes, Appendix A: Policy and Practice Actions to Improve Antibiotic Use. Once the protocols are written, our team will be sure to review this appendix to make sure we are not missing anything and then figure out how to implement the changes in step-by-step fashion so staff do not get overwhelmed by the new changes in practice.