Reducing Fluoroquinolone Use and Clostridioides difficile Infections in Community Nursing Homes Through Hospital–Nursing Home Collaboration

Felsen, Christina B.; Ashley, Elizabeth S. Dodds; Barney, Grant; Nelson, Dallas; Nicholas, J. A.; Yang, Hongmei; Aydelotte, Marie E.; Karlic, Alexander; Nicholas, Nirmala C.; Petrone, Kim; Pine, Rena D.; Schabel, Scott L.; Medina‐Walpole, Annette; Dumyati, Ghinwa

doi:10.1016/j.jamda.2019.11.010

Cited by 19 publications

(18 citation statements)

References 43 publications

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“…The project resulted in a 39% decrease in fluoroquinolone monthly days of therapy rate and an 18% decrease in the quarterly CDI rate. 8 Despite the successful implementation of the project, ASP champions voiced concerns about the long-term sustainability of the program without the HBT's support.…”

mentioning

confidence: 99%

“…Because sustainability of any quality-improvement project requires integrating practices into daily operations, 9 following our 5-year collaborative project, 8 we sought to understand the factors that influence the sustainability of ASPs. We examined the experiences and perceptions of clinical and administrative staff across the collaborative nursing homes, and we utilized a sustainability framework 9 to inform policies and practices for sustainability and to provide specific recommendations for ASP sustainability in nursing homes.…”

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confidence: 99%

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

Seshadri

Felsen

Sellers

et al. 2020

Infect. Control Hosp. Epidemiol.

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Objective: To describe nursing home staff experiences and perceptions of the factors that impact the sustainability of an antibiotic stewardship program (ASP). Methods: Using a qualitative descriptive design, semistructured interviews with staff at 9 not-for-profit nursing homes with an established ASP were conducted and audio recorded. De-identified transcriptions of the interviews were coded using a sustainability framework and were analyzed to identify themes. Results: Interviews were conducted with 48 clinical and administrative staff to elicit their perceptions of the ASPs, and 7 themes were identified. ASPs were perceived to be resource intensive and “data driven,” requiring access to and interpretation of data that are not readily available at many nursing homes. Though motivated and committed, ASP champions felt that they could not single-handedly sustain the program. Attending to daily clinical needs (ie, “fires”) made it hard to progress beyond implementation and to reach step 2 of sustainability. Longstanding treatment habits by external prescribers and regulations were believed to impede ASP efforts. Partnerships with an external consultant with antibiotic stewardship expertise were considered important, as was the need for internal leadership support and collaboration across disciplinary boundaries. Participants felt that consistent and ongoing education on antibiotic stewardship at all staff levels was important. Conclusions: Although many interconnected factors impact the sustainability of an ASP, nursing homes may be able to sustain an ASP by focusing on 3 critical areas: (1) explicit support by nursing home leadership, (2) external partnerships with professionals with antibiotic stewardship expertise and internal interprofessional collaborations, and (3) consistent education and training for all staff.

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confidence: 99%

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confidence: 99%

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

Seshadri

Felsen

Sellers

et al. 2020

Infect. Control Hosp. Epidemiol.

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“…A second potential reason is that of “noninterference,” in which the nursing home prescriber is reluctant to change an antibiotic started by another clinician, particularly those practicing in acute care 34 . Targeting antibiotic stewardship efforts to reduce the use of fluoroquinolones may help reduce the risk of serious adverse events, 35 as well as the acquisition of resistant Gram‐negative bacilli and Clostridioides difficile infections among nursing home residents 36‐38 …”

Section: Discussionmentioning

confidence: 99%

“…34 Targeting antibiotic stewardship efforts to reduce the use of fluoroquinolones may help reduce the risk of serious adverse events, 35 as well as the acquisition of resistant Gram-negative bacilli and Clostridioides difficile infections among nursing home residents. [36][37][38] Pharmacy invoices are available to all nursing homes and may be used as a consistent, readily available data source. 10,11 Invoices paid by the nursing home should capture prescriptions filled through Medicare Parts A and C, indicating residents receiving skilled care through benefits provided through hospital benefits or managed care, respectively.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Use Among Residents Receiving Skilled Nursing Care in 29 U.S. Nursing Homes

Song

Wilson

Bej

et al. 2020

J American Geriatrics Society

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BACKGROUND Data describing antibiotic use in U.S. nursing homes remain limited. We report antibiotic use among skilled nursing facility residents from 29 U.S. nursing homes and assessed correlations between antibiotics prescribed to residents in skilled care and nursing home characteristics. DESIGN Retrospective cohort study. SETTING Twenty‐nine U.S. nursing homes in the same healthcare corporation. PARTICIPANTS Residents receiving skilled care in 2016. MEASUREMENTS We used pharmacy invoice and nursing home census data to calculate the days of antibiotic therapy per 1,000 days of skilled care (1,000 DOSC), the rate of antibiotic starts per 1,000 DOSC, the length of antibiotic therapy, and the average antibiotic spectrum index. We also assessed correlations between antibiotic use and nursing home characteristics. RESULTS Antibiotics accounted for an average of 9.6% (±0.6%) of systemic medications prescribed among residents receiving skilled care. On average, 26.8% (±2.9%) of antibiotics were intravenous. Fluoroquinolones were prescribed at the highest rates (19% across all facilities), followed by beta‐lactam/beta‐lactamase inhibitors (11%), first‐ and second‐generation cephalosporins, sulfonamides, and oral tetracyclines (each at 9%). Both the proportion of residents using enrolled in Medicare and number of unique prescribers responsible for systemic prescriptions positively correlated with the rate of antibiotic starts. CONCLUSIONS Our study demonstrates that pharmacy invoices represent a useful and preexisting source of data for assessing antibiotic prescriptions among individuals receiving skilled nursing care. The correlation between the number of unique prescribers and antibiotic starts suggests that prescribers are central to efforts to improve antibiotic use in nursing homes.

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“…This issue of JAMDA includes 3 studies documenting further progress in this areada description of antibiotic stewardship initiatives in 4 European countries, 34 research documenting impressive reductions in antibiotic use and interfacility variability after the introduction of guidelines in Switzerland, 35 and a small but impactful study documenting not only a decline in antibiotic use but also reductions in C difficile infections in a collaborative project between a hospital infectious disease team and several local nursing homes. 36…”

Section: Antibiotic Stewardshipmentioning

confidence: 99%

Progress and Challenges in the Management of Nursing Home Infections

Sloane

Zimmerman

Nace

2020

Journal of the American Medical Directors Association

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Reducing Fluoroquinolone Use and Clostridioides difficile Infections in Community Nursing Homes Through Hospital–Nursing Home Collaboration

Cited by 19 publications

References 43 publications

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

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

Antibiotic Use Among Residents Receiving Skilled Nursing Care in 29 U.S. Nursing Homes

Progress and Challenges in the Management of Nursing Home Infections

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