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Katz MJ, Tamma PD, Cosgrove SE, Miller MA, Dullabh P, Rowe TA, Ahn R, Speck K, Gao Y, Shah S, Jump RLP. Implementation of an Antibiotic Stewardship Program in Long-term Care Facilities Across the US. JAMA Netw Open 2022; 5:e220181. [PMID: 35226084 PMCID: PMC8886516 DOI: 10.1001/jamanetworkopen.2022.0181] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Antibiotic overuse in long-term care (LTC) is common, prompting calls for antibiotic stewardship programs (ASPs) designed for specific use in these settings. The optimal approach to establish robust, sustainable ASPs in LTC facilities is unknown. OBJECTIVES To determine if the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use, an educational initiative to establish ASPs focusing on patient safety, is associated with reductions in antibiotic use in LTC settings. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study including 439 LTC facilities in the US assessed antibiotic therapy data following a pragmatic quality-improvement program, which was implemented to assist facilities in establishing ASPs and with antibiotic decision-making. Training was conducted between December 2018 and November 2019. Data were analyzed from January 2019 to December 2019. INTERVENTIONS Fifteen webinars occurred over 12 months (December 2018 to November 2019), accompanied by additional tools, activities, posters, and pocket cards. All clinical staff were encouraged to participate. MAIN OUTCOMES AND MEASURES The primary outcome was antibiotic starts per 1000 resident-days. Secondary outcomes included days of antibiotic therapy (DOT) per 1000 resident-days, the number of urine cultures per 1000 resident-days, and Clostridioides difficile laboratory-identified events per 10 000 resident-days. All outcomes compared data from the baseline (January-February 2019) to the completion of the program (November-December 2019). Generalized linear mixed models with random intercepts at the site level assessed changes over time. RESULTS Of a total 523 eligible LTC facilities, 439 (83.9%) completed the safety program. The mean difference for antibiotic starts from baseline to study completion per 1000 resident-days was -0.41 (95% CI, -0.76 to -0.07; P = .02), with fluoroquinolones showing the greatest decrease at -0.21 starts per 1000 resident-days (95% CI, -0.35 to -0.08; P = .002). The mean difference for antibiotic DOT per 1000 resident-days was not significant (-3.05; 95% CI, -6.34 to 0.23; P = .07). Reductions in antibiotic starts and use were greater in facilities with greater program engagement (as measured by webinar attendance). While antibiotic starts and DOT in these facilities decreased by 1.12 per 1000 resident-days (95% CI, -1.75 to -0.49; P < .001) and 9.97 per 1000 resident-days (95% CI, -15.4 to -4.6; P < .001), respectively, no significant reductions occurred in low engagement facilities. Urine cultures per 1000 resident-days decreased by 0.38 (95% CI, -0.61 to -0.15; P = .001). There was no significant change in facility-onset C difficile laboratory-identified events. CONCLUSIONS AND RELEVANCE Participation in the AHRQ safety program was associated with the development of ASPs that actively engaged clinical staff in the decision-making processes around antibiotic prescriptions in participating LTC facilities. The reduction in antibiotic DOT and starts, which was more pronounced in more engaged facilities, indicates that implementation of this multifaceted program may support successful ASPs in LTC settings.
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Affiliation(s)
- Morgan J. Katz
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pranita D. Tamma
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sara E. Cosgrove
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Melissa A. Miller
- Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, Maryland
| | | | | | - Roy Ahn
- NORC at the University of Chicago, Chicago, Illinois
| | - Kathleen Speck
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yue Gao
- NORC at the University of Chicago, Bethesda, Maryland
| | | | - Robin L. P. Jump
- Geriatric Research Education and Clinical Center, VA Northeast Ohio Healthcare System, Cleveland, Ohio
- Case Western Reserve University School of Medicine, Cleveland, Ohio
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Song S, Wilson BM, Marek J, Jump RLP. Use of electronic pharmacy transaction data and website development to assess antibiotic use in nursing homes. BMC Med Inform Decis Mak 2021; 21:148. [PMID: 33952239 PMCID: PMC8097250 DOI: 10.1186/s12911-021-01509-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2017, the Centers for Medicare and Medicaid Services required all long-term care facilities, including nursing homes, to have an antibiotic stewardship program. Many nursing homes lack the resources, expertise, or infrastructure to track and analyze antibiotic use measures. Here, we demonstrate that pharmacy invoices are a viable source of data to track and report antibiotic use in nursing homes. METHODS The dispensing pharmacy working with several nursing homes in the same healthcare corporation provided pharmacy invoices from 2014 to 2016 as files formatted as comma separated values. We aggregated these files by aligning elements into a consistent set of variables and assessed the completeness of data from each nursing home over time. Data cleaning involved removing rows that did not describe systemic medications, de-duplication, consolidating prescription refills, and removing prescriptions for insulin and opioids, which are medications that were not administered at a regular dose or schedule. After merging this cleaned invoice data to nursing home census data including bed days of care and publicly available data characterizing bed allocation for each nursing home, we used the resulting database to describe several antibiotic use metrics and generated an interactive website to permit further analysis. RESULTS The resultant database permitted assessment of the following antibiotic use metrics: days of antibiotic therapy, length of antibiotic therapy, rate of antibiotic starts, and the antibiotic spectrum index. Further, we created a template for summarizing data within a facility and comparing across facilities. https://sunahsong.shinyapps.io/USNursingHomes/ . CONCLUSIONS Lack of resources and infrastructure contributes to challenges facing nursing homes as they develop antibiotic stewardship programs. Our experience with using pharmacy invoice data may serve as a useful approach for nursing homes to track and report antibiotic use.
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Affiliation(s)
- Sunah Song
- Cleveland Institute for Computational Biology, Cleveland, OH, USA.,Department of Computer and Data Sciences, School of Engineering, Case Western Reserve University, Cleveland, OH, USA.,Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Brigid M Wilson
- Division of Infectious Diseases and HIV Medicine in the Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.,Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs (VA) Northeast Ohio Healthcare System, 10701 East Blvd., Cleveland, OH, 44106, USA
| | - Joseph Marek
- CommuniCare Health Services, Cincinnati, OH, USA
| | - Robin L P Jump
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA. .,Division of Infectious Diseases and HIV Medicine in the Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH, USA. .,Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs (VA) Northeast Ohio Healthcare System, 10701 East Blvd., Cleveland, OH, 44106, USA.
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Description of antibiotic use variability among US nursing homes using electronic health record data. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY 2021; 1:e58. [PMID: 36168476 PMCID: PMC9495428 DOI: 10.1017/ash.2021.207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 11/06/2022]
Abstract
Abstract
Background:
Antibiotics are frequently prescribed in nursing homes; national data describing facility-level antibiotic use are lacking. The objective of this analysis was to describe variability in antibiotic use in nursing homes across the United States using electronic health record orders.
Methods:
A retrospective cohort study of antibiotic orders for 309,884 residents in 1,664 US nursing homes in 2016 were included in the analysis. Antibiotic use rates were calculated as antibiotic days of therapy (DOT) per 1,000 resident days and were compared by type of stay (short stay ≤100 days vs long stay >100 days). Prescribing indications and the duration of nursing home-initiated antibiotic orders were described. Facility-level correlations of antibiotic use, adjusting for resident health and facility characteristics, were assessed using multivariate linear regression models.
Results:
In 2016, 54% of residents received at least 1 systemic antibiotic. The overall rate of antibiotic use was 88 DOT per 1,000 resident days. The 3 most common antibiotic classes prescribed were fluoroquinolones (18%), cephalosporins (18%), and urinary anti-infectives (9%). Antibiotics were most frequently prescribed for urinary tract infections, and the median duration of an antibiotic course was 7 days (interquartile range, 5–10). Higher facility antibiotic use rates correlated positively with higher proportions of short-stay residents, for-profit ownership, residents with low cognitive performance, and having at least 1 resident on a ventilator. Available facility-level characteristics only predicted a small proportion of variability observed (Model R2 version 0.24 software).
Conclusions:
Using electronic health record orders, variability was found among US nursing-home antibiotic prescribing practices, highlighting potential opportunities for targeted improvement of prescribing practices.
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Sibani M, Mazzaferri F, Carrara E, Pezzani MD, Arieti F, Göpel S, Paul M, Tacconelli E, Mutters NT, Voss A. White Paper: Bridging the gap between surveillance data and antimicrobial stewardship in long-term care facilities-practical guidance from the JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks. J Antimicrob Chemother 2020; 75:ii33-ii41. [PMID: 33280047 PMCID: PMC7719406 DOI: 10.1093/jac/dkaa427] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In long-term care facilities (LTCFs) residents often receive inappropriate antibiotic treatment and infection prevention and control practices are frequently inadequate, thus favouring acquisition of MDR organisms. There is increasing evidence in the literature describing antimicrobial stewardship (AMS) activities in LTCFs, but practical guidance on how surveillance data should be linked with AMS activities in this setting is lacking. To bridge this gap, the JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks joined their efforts to provide practical guidance for linking surveillance data with AMS activities. MATERIALS AND METHODS Considering the three main topics [AMS leadership and accountability, antimicrobial usage (AMU) and AMS, and antimicrobial resistance (AMR) and AMS], a literature review was performed and a list of target actions was developed. Consensus on target actions was reached through a RAND-modified Delphi process involving 40 experts from 18 countries and different professional backgrounds adopting a One Health approach. RESULTS From the 25 documents identified, 25 target actions were retrieved and proposed for expert evaluation. The consensus process produced a practical checklist including 23 target actions, differentiating between essential and desirable targets according to clinical relevance and feasibility. Flexible proposals for AMS team composition and leadership were provided, with a strong emphasis on the need for well-defined and adequately supported roles and responsibilities. Specific antimicrobial classes, AMU metrics, pathogens and resistance patterns to be monitored are addressed. Effective reporting strategies are described. CONCLUSIONS The proposed checklist represents a practical tool to support local AMS teams across a wide range of care delivery organization and availability of resources.
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Affiliation(s)
- Marcella Sibani
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Fulvia Mazzaferri
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Elena Carrara
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Maria Diletta Pezzani
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Fabiana Arieti
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Siri Göpel
- Infectious Diseases, Department of Internal Medicine I, Tübingen University Hospital, Tübingen, Germany
- German Centre for Infection Research (DZIF), Clinical Research Unit for Healthcare Associated Infections, Tübingen, Germany
| | - Mical Paul
- Diseases Institute, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Evelina Tacconelli
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
- Infectious Diseases, Department of Internal Medicine I, Tübingen University Hospital, Tübingen, Germany
- German Centre for Infection Research (DZIF), Clinical Research Unit for Healthcare Associated Infections, Tübingen, Germany
| | - Nico T Mutters
- Institute for Hygiene and Public Health, Bonn University Hospital, Bonn, Germany
| | - Andreas Voss
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Innovative methods to summarize nursing home antibiotic data. Infect Control Hosp Epidemiol 2019; 40:1210-1211. [DOI: 10.1017/ice.2019.226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Plüss-Suard C, Niquille A, Héquet D, Krähenbühl S, Pichon R, Zanetti G, Bugnon O, Petignat C. Decrease in Antibacterial Use and Facility-Level Variability After the Introduction of Guidelines and Implementation of Physician-Pharmacist-Nurse Quality Circles in Swiss Long-term Care Facilities. J Am Med Dir Assoc 2019; 21:78-83. [PMID: 31327571 DOI: 10.1016/j.jamda.2019.05.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 05/16/2019] [Accepted: 05/18/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The objective of this study is to describe antibacterial use in long-term care facilities and to investigate the determinants of use. DESIGN This study is a quality improvement study conducted from January 2011 to December 2016. SETTING Long-term care facilities in the canton of Vaud, Western Switzerland, were investigated. PARTICIPANTS Twenty-three long-term care facilities were included in this study. INTERVENTION The intervention included the publication of local guidelines on empirical antibacterial therapy and the implementation of physician-pharmacist-nurse quality circles. MEASURES The main outcome was antibacterial use, expressed as defined daily doses (DDD) per 1000 beds per day. Statistical analyses were performed through a 1-level mixed model for repeated measurements. RESULTS Antibacterial use decreased from 45.6 to 35.5 DDD per 1000 beds per day (-22%, P < .01) over the 6-year study period, which was mostly explained by reduced fluoroquinolone use (-59%, P < .001). A decrease in range of use among LTCFs was observed during the study period, and 27% of antibacterial use was related to the WATCH group (antibiotics with higher toxicity concerns and/or resistance potential) according to the AWaRe categorization of the WHO, decreasing from 17.3 DDD per 1000 beds per day to 9.5 (-45%) over the study period. The use of antibacterials from the RESERVE group ("last-resort" treatment options) was very low. CONCLUSION AND IMPLICATIONS A reduction in facility-level antibacterial use and in variability across LTCFs was observed over the study period. The dissemination of empirical antibacterial prescription guidelines and the implementation of physician-pharmacist-nurse quality circles in all LTCFs of the canton of Vaud likely contributed to this reduction. Antibacterials from the WATCH group still represented 27% of the total use, providing targets for future antibiotic stewardship activities.
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Affiliation(s)
- Catherine Plüss-Suard
- Service of Hospital Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland.
| | - Anne Niquille
- Community Pharmacy Center, Department of Ambulatory Care & Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Delphine Héquet
- Service of Hospital Preventive Medicine, Lausanne University Hospital, and Cantonal Unit for Infection Control and Prevention, Public Health Service, Lausanne, Switzerland
| | | | - Renaud Pichon
- Pharmacie des Hôpitaux du Nord Vaudois et de la Broye, Yverdon-les-Bains, Switzerland
| | - Giorgio Zanetti
- Service of Hospital Preventive Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olivier Bugnon
- Community Pharmacy Center, Department of Ambulatory Care & Community Medicine, University of Lausanne, Lausanne, Switzerland; Community Pharmacy Practice Research, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Lausanne, Switzerland
| | - Christiane Petignat
- Service of Hospital Preventive Medicine, Lausanne University Hospital, and Cantonal Unit for Infection Control and Prevention, Public Health Service, Lausanne, Switzerland.
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Potential utility of pharmacy data to measure antibiotic use in nursing homes. Infect Control Hosp Epidemiol 2019; 40:819-820. [PMID: 31014405 DOI: 10.1017/ice.2019.95] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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One-day point prevalence as a method for estimating antibiotic use in nursing homes. Infect Control Hosp Epidemiol 2018; 40:221-223. [PMID: 30516118 DOI: 10.1017/ice.2018.309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Antibiotic use tracking in nursing homes is necessary for stewardship and regulatory requirements but may be burdensome. We used pharmacy data to evaluate whether once-weekly sampling of antibiotic use can estimate total use; we found no significant differences in estimated and measured antibiotic use.
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McElligott M, Welham G, Pop-Vicas A, Taylor L, Crnich CJ. Antibiotic Stewardship in Nursing Facilities. Infect Dis Clin North Am 2018; 31:619-638. [PMID: 29079152 DOI: 10.1016/j.idc.2017.07.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Misuse and overuse of antibiotic therapy is a frequent cause of resident harm in nursing facilities. As a result, newly released policy and regulatory initiatives will require antibiotic stewardship programs (ASPs) in nursing facilities. Although implementing ASPs can be challenging, improving the quality of antibiotic prescribing is achievable in this setting. The authors review the determinants of antibiotic prescribing in nursing facilities, strategies to improve antibiotic prescribing in this setting, current status of ASPs in nursing facilities, and steps that facilities can take to enhance existing ASP structure and process.
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Affiliation(s)
- Miranda McElligott
- University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
| | - Grace Welham
- University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA
| | - Aurora Pop-Vicas
- University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA; University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Lyndsay Taylor
- University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Christopher J Crnich
- University of Wisconsin, School of Medicine and Public Health, Madison, WI, USA; University of Wisconsin Hospital and Clinics, Madison, WI, USA; William S. Middleton Veterans Affairs Hospital, Madison, WI, USA.
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Jump RLP, Crnich CJ, Mody L, Bradley SF, Nicolle LE, Yoshikawa TT. Infectious Diseases in Older Adults of Long-Term Care Facilities: Update on Approach to Diagnosis and Management. J Am Geriatr Soc 2018; 66:789-803. [PMID: 29667186 PMCID: PMC5909836 DOI: 10.1111/jgs.15248] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The diagnosis, treatment, and prevention of infectious diseases in older adults in long-term care facilities (LTCFs), particularly nursing facilities, remains a challenge for all health providers who care for this population. This review provides updated information on the currently most important challenges of infectious diseases in LTCFs. With the increasing prescribing of antibiotics in older adults, particularly in LTCFs, the topic of antibiotic stewardship is presented in this review. Following this discussion, salient points on clinical relevance, clinical presentation, diagnostic approach, therapy, and prevention are discussed for skin and soft tissue infections, infectious diarrhea (Clostridium difficile and norovirus infections), bacterial pneumonia, and urinary tract infection, as well as some of the newer approaches to preventive interventions in the LTCF setting.
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Affiliation(s)
- Robin L P Jump
- Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
- Specialty Care Center of Innovation, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
- Division of Infectious Diseases and HIV Medicine, Department of Medicine and Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Christopher J Crnich
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
- William S. Middleton Veterans Affairs Medical Center, Madison, Wisconsin
- University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Lona Mody
- Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Division of Geriatric and Palliative Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Suzanne F Bradley
- Division of Infectious Diseases, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Lindsay E Nicolle
- Department of Internal Medicine, Health Sciences Centre, University of Manitoba, Winnepeg, Manitoba, Canada
- Department of Medical Microbiology, Health Sciences Centre, University of Manitoba, Winnepeg, Manitoba, Canada
| | - Thomas T Yoshikawa
- Geriatric and Extended Care Service, Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- Department of Medicine, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
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Jump RLP, Gaur S, Katz MJ, Crnich CJ, Dumyati G, Ashraf MS, Frentzel E, Schweon SJ, Sloane P, Nace D. Template for an Antibiotic Stewardship Policy for Post-Acute and Long-Term Care Settings. J Am Med Dir Assoc 2017; 18:913-920. [PMID: 28935515 DOI: 10.1016/j.jamda.2017.07.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 07/28/2017] [Indexed: 01/22/2023]
Abstract
In response to a rising concern for multidrug resistance and Clostridium difficile infections, the Centers for Medicare and Medicaid services (CMS) will require all long-term care (LTC) facilities to establish an antibiotic stewardship program by November 2017. Thus far, limited evidence describes implementation of antibiotic stewardship in LTC facilities, mostly in academic- or hospital-affiliated settings. To support compliance with CMS requirements and aid facilities in establishing a stewardship program, the Infection Advisory Committee at AMDA-The Society for Post-Acute and Long-Term Care Medicine, has developed an antibiotic stewardship policy template tailored to the LTC setting. The intent of this policy, which can be adapted by individual facilities, is to help LTC facilities implement an antibiotic stewardship policy that will meet or exceed CMS requirements. We also briefly discuss implementation of an antibiotic stewardship program in LTC settings, including a list of free resources to support those efforts.
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Affiliation(s)
- Robin L P Jump
- Geriatric Research Education and Clinical Center (GRECC), Specialty Care Center of Innovation and Infectious Disease Section, Louis Stokes Cleveland Veterans Affairs Medical Center (VAMC), Cleveland, OH; Division of Infectious Diseases and HIV Medicine, Department of Medicine and Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH.
| | - Swati Gaur
- New Horizons Nursing Facilities, Gainesville, GA
| | - Morgan J Katz
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christopher J Crnich
- University of Wisconsin School of Medicine and Public Health, Department of Medicine, Madison, WI; William S. Middleton VA Hospital, Department of Medicine, Madison, WI
| | - Ghinwa Dumyati
- Infectious Diseases Division and Center for Community Health, University of Rochester Medical Center, Rochester, NY
| | - Muhammad S Ashraf
- Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | | | | | - Philip Sloane
- Department of Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - David Nace
- Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA
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