Errors in antibiotic transitions between hospital and nursing home: How often do they occur?

Dickinson, Drew T; Rashid, Syma; Weiland, Anastasiia; Tjoa, Thomas; Kim, Diane S.; Huang, Susan S.

doi:10.1017/ice.2019.270

Cited by 6 publications

(4 citation statements)

References 8 publications

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“…41,42 Given reduced antibiotic stewardship oversight, poor discharge documentation, and frequent empirical and broad-spectrum prescribing practices, antibiotic prescribing on discharge to NH is associated with adverse events, including rehospitalization and CDI. [41][42][43][44] Alongside the large proportion of patients receiving a hospitalassociated prescriptions, nearly one-fifth of enrolled patients received an NH-associated prescription for a new indication during their NH stay, predominantly for UTIs. Previous research demonstrated that NH antibiotic prescribing is often inappropriate, with some estimates surpassing 50%, particularly due to inappropriate urine culturing and treatment of asymptomatic bacteriuria.…”

Section: Discussionmentioning

confidence: 99%

Association of Exposure to High-risk Antibiotics in Acute Care Hospitals With Multidrug-Resistant Organism Burden in Nursing Homes

et al. 2022

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IMPORTANCELittle is known about the contribution of hospital antibiotic prescribing to multidrugresistant organism (MDRO) burden in nursing homes (NHs). OBJECTIVESTo characterize antibiotic exposures across the NH patient's health care continuum (preceding health care exposure and NH stay) and to investigate whether recent antibiotic exposure is associated with MDRO colonization and room environment contamination at NH study enrollment. DESIGN, SETTING, AND PARTICIPANTS This is a secondary analysis of a prospective cohort study (conducted from 2013-2016) that enrolled NH patients and followed them up for as long as 6 months. The study was conducted in 6 NHs in Michigan among NH patients who were enrolled within 14 days of admission. Clinical metadata abstraction, multi-anatomical site screening, and room environment surveillance for MDROs were conducted at each study visit. Data were analyzed between May 2019 and November 2021. EXPOSURES Antibiotic data were abstracted from NH electronic medical records by trained research staff and characterized by class, route, indication, location of therapy initiation, risk for Clostridioides difficile infection (C diffogenic agents), and 2019 World Health Organization Access, Watch, and Reserve (AWARE) antibiotic stewardship framework categories. MAIN OUTCOMES AND MEASURESThe primary outcomes were MDRO colonization and MDRO room environment contamination at NH study enrollment, measured using standard microbiology methods. Multivariable logistic regression was used to identify whether antibiotic exposure within 60 days was associated with MDRO burden at NH study enrollment. Additionally, antibiotic exposure data were characterized using descriptive statistics. RESULTSA total of 642 patients were included (mean [SD] age, 74.7 [12.2] years; 369 [57.5%] women; 402 [62.6%] White; median [IQR] NH days to enrollment, 6.0 [3.0-7.0]). Of these, 422 (65.7%) received 1191 antibiotic exposures: 368 (57.3%) received 971 hospital-associated prescriptions, and 119 (18.5%) received 198 NH-associated prescriptions. Overall, 283 patients (44.1%) received at least 1 C diffogenic agent, and 322 (50.2%) received at least 1 high-risk WHO AWARE antibiotic (watch or reserve agent). More than half of NH patients (364 [56.7%]) and room environments (437 [68.1%]) had MDRO-positive results at enrollment. In multivariable analysis, recent antibiotic exposure was positively associated with baseline MDRO colonization (odds ratio [

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Section: Discussionmentioning

confidence: 99%

Association of Exposure to High-risk Antibiotics in Acute Care Hospitals With Multidrug-Resistant Organism Burden in Nursing Homes

et al. 2022

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“…Sparked by the identification of opportunities for improved prescribing in this setting, applications of similar strategies during transitions of care have arisen more recently. In a 2019 systematic review of 40 paired hospital and nursing home sites, Dickinson and colleagues reported that approximately 30% of transitions involved an inappropriate change to the antibiotic plan of care, thus establishing a significant area ripe for improvement [ 26 ]. With increasing recognition for its value, preliminary studies assessing stewardship services at transitions of care have illustrated promising results.…”

Section: Stewardship Foundationsmentioning

confidence: 99%

Antimicrobial Stewardship at Transitions of Care to Outpatient Settings: Synopsis and Strategies

2022

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Inappropriate antibiotic use and associated consequences, including pathogen resistance and Clostridioides difficile infection, continue to serve as significant threats in the United States, with increasing incidence in the community setting. While much attention has been granted towards antimicrobial stewardship in acute care settings, the transition to the outpatient setting represents a significant yet overlooked area to target optimized antimicrobial utilization. In this article, we highlight notable areas for improved practices and present an interventional approach to stewardship tactics with a framework of disease, drug, dose, and duration. In doing so, we review current evidence regarding stewardship strategies at transitional settings, including diagnostic guidance, technological clinical support, and behavioral and educational approaches for both providers and patients.

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“…auf weniger breitwirksame Therapie bei Ausschluss eines entsprechend resistenten Erregers, Dosis und Dauer sind in vielen Krankenhausabteilungen Optimierungsbereiche identifizierbar. Dies gilt auch für Empfehlungen zur Weiterführung von Therapien bei Entlassungein Bereich, der bisher noch zu wenig Beachtung gefunden hat [21].…”

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Fehler und Optimierungsbereiche bei der Verordnung von Antibiotika

Kern¹

2020

Dtsch Med Wochenschr

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Inadequate antibiotic prescribing has been observed in many settings both in hospitals as well as in primary care. Most often there is uncertainty about the indication for antibiotic treatment itself, prescribers are reluctant to deescalate, and therapy duration is too long which results most often in overprescribing. The burden of overprescribing is difficult to estimate, but many studies in the hospital setting report a rate of approximately 30 % of inadequate prescribing – with wide variation. Over- but also underprescribing of antimicrobial agents is a serious patient safety issue that needs to be addressed in specific programmes at different levels of the healthcare system. Interventional studies have shown that programmes implementing or intensifying audit and feedback with clinical reevaluation by experts can be very efficient to reduce inadequate prescribing.

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Errors in antibiotic transitions between hospital and nursing home: How often do they occur?

Cited by 6 publications

References 8 publications

Association of Exposure to High-risk Antibiotics in Acute Care Hospitals With Multidrug-Resistant Organism Burden in Nursing Homes

Association of Exposure to High-risk Antibiotics in Acute Care Hospitals With Multidrug-Resistant Organism Burden in Nursing Homes

Antimicrobial Stewardship at Transitions of Care to Outpatient Settings: Synopsis and Strategies

Fehler und Optimierungsbereiche bei der Verordnung von Antibiotika

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