Characteristics of nursing homes with comprehensive antibiotic stewardship programs: Results of a national survey

Abstract

Background: Antibiotic stewardship in nursing homes (NHs) is a high priority owing to intense antibiotic use and increased risk of adverse events. Updated Centers for Medicare and Medicaid Services regulations required NHs to establish antibiotic stewardship programs (ASPs). This study describes the current state of NH ASPs. Methods: A nationally representative survey of NHs was conducted in 2018. ASP comprehensiveness, infection preventionist (IP) training, participation in Quality Innovation Network-Quality Improvement Organization (QIN-QIO) activities, and facility and staff characteristics were analyzed using weighted descriptive statistics and multinomial regression models. Results: Of 861 NHs, 33.2% (6-7) had "comprehensive" ASP policies, 41.1% (4-5) had "moderately comprehensive" ASP policies, and 25.6% (≤ 3) had "not comprehensive" ASP policies. Data collection on antibiotic use was most reported (91.4%), and restricting use of specific antibiotics was least reported (19.0%). Comprehensive ASPs were associated with QIN-QIO involvement; moderate and comprehensive ASPs were associated with IP training and high occupancy. Discussion: Immediately following Centers for Medicare and Medicaid Services regulation changes, a majority of NHs had moderately comprehensive or comprehensive ASPs. Rates for each policy and infection control-trained IPs increased from previous studies. Conclusions: NH ASPs are becoming more comprehensive. Infection control training and partnerships with QIN-QIOs can support NHs to increase ASP comprehensiveness.

“There is no one to pick up the pieces”: Sustainability of antibiotic stewardship programs in nursing homes

“…Similarly, the limited access to resources including time, personnel, and funds, 22,31 hindered the implementation and sustainability of ASPs. 32 During the collaborative project, the HBT provided many of these resources, mitigating some antibiotic stewardship-related costs for nursing homes. However, after the project ended, ASP sustainability was in jeopardy.…”

The impact of health care provider relationships and communication dynamics on urinary tract infection management and antibiotic utilization for long-term care facility residents treated in the emergency department: A qualitative study

“…The conversation is the huge piece that I'm trying to get to my nurses is painting the picture for the physician, the things that the patient is exhibiting and then also the things that have not changed, that they're still doing well. 41 The 2017 CMS requirement required the development of antibiotic stewardship programs in LTCF. This requirement gave more social responsibility and autonomy to nursing staff, as the process for initiation and de-escalation involves interpersonal communication with nurses and physicians from other facilities about both facts and personal judgments.…”

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

“…However, this aspect requires revision of each prescription and reference standards, which are not constantly available in LTCFs, especially where GPs are responsible for prescribing antibiotics. 30 , 50 …”