Implementation of the Core Elements of Antibiotic Stewardship in Long-Term Care Facilities

Roberts, Colleen; Buechel, Katherine; Tobey, Kelley; Evans, Christopher; Talley, Pamela; Kainer, Marion

doi:10.1016/j.ajic.2018.04.062

Cited by 3 publications

(4 citation statements)

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“…This study presents nationally representative data on NH ASP comprehensiveness concurrent with and immediately following the implementation deadline for the new CMS requirements. 29 Similar to other studies that evaluated antibiotic stewardship implementation directly using the framework of the CDC core elements, 45,46 we examined comprehensive ASPs through a number of specific policies and practices that fell under 4 of the 7 core elements (action, tracking, reporting, and education). Overall, 6 out of 7 ASPs had implementation rates of 63% or higher, and only 4 NHs reported not having any of the policies in place, showing progress in the development of NH ASPs compared with a previous national survey.…”

Section: Discussionmentioning

confidence: 99%

“…State-based assessments from 2011-2017 found that many NHs were already collecting data on antibiotic prescriptions, although there was wide variation by state, from 23%, with antibiotic tracking policies in Tennessee in 2016-2017, to 98.5% of NHs tracking antibiotic starts in Wisconsin in 2015. 45,[47][48][49][50][51][52][53] Similarly, in the 2016 annual national survey of NHs enrolled in the NHSN long-term care facility component, 95% reported that they tracked antibiotic use. 46 The policy that was least adopted overall was restricting the use of specific antibiotics; in the comprehensive ASP group, where all other policies had 98% or higher rates of adoption, only 45% reported implemented this policy.…”

Section: Discussionmentioning

confidence: 99%

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

Mantell

Agarwal

2020

American Journal of Infection Control

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Mantell

Agarwal

2020

American Journal of Infection Control

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“…The US Centers for Disease Control and Prevention recommended that all acute care hospitals implement an ASP, considering the urgent need to improve antimicrobial use in hospitals and the benefits of an ASP and published the core elements of an effective hospital ASP in 2014 [ 96 ]. It proposed a range of core elements for different types of medical facility, including hospitals, outpatient hospitals, nursing homes or long-term care facilities, small-size acute care hospitals, and resource-limited settings.…”

Section: Recommended Guidelines For Each Key Questionmentioning

confidence: 99%

Guidelines on Implementing Antimicrobial Stewardship Programs in Korea

et al. 2021

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These guidelines were developed as a part of the 2021 Academic R&D Service Project of the Korea Disease Control and Prevention Agency in response to requests from healthcare professionals in clinical practice for guidance on developing antimicrobial stewardship programs (ASPs). These guidelines were developed by means of a systematic literature review and a summary of recent literature, in which evidence-based intervention methods were used to address key questions about the appropriate use of antimicrobial agents and ASP expansion. These guidelines also provide evidence of the effectiveness of ASPs and describe intervention methods applicable in Korea.

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“…[8][9][10][11] As such, there is an urgent need to improve the quality of antibiotic prescribing in nursing homes. [12][13][14] Although most nursing-home stewardship interventions have focused on reducing unnecessary antibiotic use, 5 significant improvements in antibiotic use may be achieved by modifying active antibiotic orders through a process commonly referred to as an "antibiotic time-out (ATO)." 15 As a stewardship strategy, the ATO prompts reassessment of an antibiotic prescription once more clinical information becomes available.…”

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confidence: 99%

Effect of antibiotic time-outs on modification of antibiotic prescriptions in nursing homes

Liao

Nace

Crnich

et al. 2020

Infect. Control Hosp. Epidemiol.

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Background:Antibiotic overuse and misuse is a common problem in nursing homes. Antibiotic time-out (ATO) interventions have led to improvements in antibiotic uses in hospitals, but their impact in nursing homes remain understudied.Objective:To evaluate the impact of a stewardship intervention, promoting use of ATOs on the frequency and types of antibiotic change events (ACEs) in nursing homes.Design:Controlled before-and-after intervention study.Setting:Nursing homes in Wisconsin and Pennsylvania.Method:Data on antibiotic prescriptions in 11 nursing homes were collected for 25 months. We categorized ACEs as (1) early discontinuation, (2) class modification, or (3) administration modification. Class modification ACEs were further classified based on whether the change narrowed, expanded, or had no effect on bacterial spectrum coverage. Analyses were performed using a difference-in-difference (DiD) approach.Result:Of 2,647 antibiotic events initiated in study nursing homes, 376 (14.2%) were associated with an ACE. The overall proportion of ACEs did not significantly differ between intervention and control nursing homes. Early discontinuation ACEs increased in intervention nursing homes (DiD, 2.5%; P = .01), primarily affecting residents initiated on broad-spectrum antibiotics (DiD, 2.9%; P < .01). Class modification ACEs decreased in intervention nursing homes but remained unchanged in control nursing homes.Conclusion:The impact of an ATO intervention in study nursing homes was mixed with increases in early discontinuation ACEs offset by reductions in class modification ACEs. More research on the potential value of ATO interventions in nursing homes is warranted.

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Implementation of the Core Elements of Antibiotic Stewardship in Long-Term Care Facilities

Cited by 3 publications

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

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

Guidelines on Implementing Antimicrobial Stewardship Programs in Korea

Effect of antibiotic time-outs on modification of antibiotic prescriptions in nursing homes

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