Browsing "Antibiotic Stewardship"

Antibiotic Stewardship – Entry 5

Dear Diary:

Our Antibiotic Stewardship workgroup has sure been working hard these past four months to develop our Antibiotic Stewardship Program. We feel good about what we have accomplished and are beginning to implement the program. Today, we finalized our education plan. At our next scheduled all-staff meeting, Dr. Amery will share the basics about antibiotics use and why antibiotic stewardship is important. Joanne, our IP, will give an overview at our monthly staff meetings so everyone can be up to date on our Antibiotic Stewardship Program and how we track antibiotic use.

We also put antibiotic stewardship on our agenda for the next resident council meeting and family council meeting and created a flier to explain our program. It’s important that residents and families understand the importance of antibiotic stewardship. Families often ask us to give antibiotics to their loved ones. We need to work with families to help them understand the importance of not over-prescribing and creating resistance. Since antibiotic use is a problem for all age groups, maybe families will think twice about how they approach their own physicians regarding antibiotic use!

To make sure that this program is sustained, and that we continue to evaluate how it’s going, antibiotic stewardship is now as a standing agenda item at our monthly QAPI meetings. We’ll review use data and discuss improving the program.

It has taken us several months, but I am proud of how our team came together to develop this program. We learned a lot! I wonder how other nursing homes have approached this process.

Signed, Donna

2 Comments

  • Donna,
    We have also been working on creating a family resident flier. We are at the beginning stages can you direct me to some good resources for creating this

  • Hello Kim,

    We found a great resource that the CDC developed called “What You Need to Know About Antibiotics in a Nursing Home.” You can share it with your residents and families-it will save you a lot of time. You can find it here: https://www.cdc.gov/longtermcare/pdfs/factsheet-core-elements-what-you-need-to-know.pdf . Hope that helps!

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Antibiotic Stewardship – Entry 4

Dear Diary:

Today our Antibiotic Stewardship workgroup spent time discussing how to track and report antibiotic use. Joanne, one of our clinical managers who is also serving as our infection preventionist, recently attended infection control training. She brought back some great resources to help track the infections in our facility and will take the lead in both tracking and reporting antibiotic use. Joanne attends our daily interdisciplinary meetings. We decided to add antibiotic use as a discussion item for these meetings. Joanne will use the information she learns at these meetings to determine when a new antibiotic is started. In the future, we plan on evaluating how we can use our EHR to get this information. Using the Antibiotic Stewardship Program Policy as our guide, we decided that the Infection Preventionist will be responsible for:

  • Infection surveillance and MDRO tracking
  • Collecting and reviewing data such as:
    • Type of antibiotic ordered, route of administration, antibiotic costs
    • Whether the order was made by phone, if order was given by attending physician or on-call doctor
    • Whether appropriate tests, such as cultures, were obtained before ordering an antibiotic
    • Whether the antibiotic was effective or needed to be changed during the course of treatment

Our pharmacy consultant’s role in tracking will be to review and report antibiotic usage data including numbers and kinds of antibiotics prescribed, days of therapy, and the number of residents treated each month.

Once we have gathered the data that we are tracking, Reporting is the next core element to work on. So far, we’ve decided on a reporting process:

  • The Infection Preventionist will review and report findings to our QAPI committee, which will provide feedback to facility staff.
  • The Medical  Director will give feedback to physicians on their individual prescribing patterns of cultures ordered and antibiotics prescribed, as indicated.

Signed, Donna

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Antibiotic Stewardship – Entry 3

Dear Diary:

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.

Signed, Donna

 

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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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Antibiotic Stewardship – Entry 1

Dear Diary:

Since the new nursing home regulations were published, we’ve been working hard to review and update our systems to meet the new elements of the regulations. One thing we need to develop is an antibiotic stewardship program. We’ve done a lot of urine cultures in the past, so we’ve laid some work on implementing criteria for defining urinary tract infection and when to do a culture. That’s about as far as we’ve got.

Today, I organized a meeting with our medical director, consultant pharmacist, infection preventionist, and consultant pharmacist. We decided to use the CDC’s Core Elements of Antibiotic Stewardship for Nursing Homes as our guide to develop a program that includes antibiotic use protocols and a system to monitor antibiotic use. We’ve  scheduled a meeting every month for two hours to tackle these core elements:

  • Leadership Commitment/Accountability
  • Drug Expertise/Action
  • Tracking/Reporting
  • Education

The group seems pretty nervous about this work. We have a lot to learn. I hope working on just a few elements at a time will help.

Signed, Donna

2 Comments

  • We are in the process of starting an official Antibiotic Steardship program and I am kind off nervous. I am interested in know how you coordinated this process as a team

    • Brenda, We have an antibiotic stewardship program up and running.

      The CDC has what they call: Core Elements for Antibiotic Stewardship in Nursing Homes. These items can help you formulate your policy.

      Leadership Commitment
      Accountability
      Drug Expertise
      Action through Policy and Practice Change
      Tracking Antibiotic Use and Outcomes
      Reporting
      Education

      Hope this helps?

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