Template for an Antibiotic Stewardship Policy for Post-Acute and Long-Term Care Settings

Abstract

In response to a rising concern for multi-drug resistance and Clostridium difficile infections, the Centers for Medicare & Medicaid services (CMS) will require all long-term care facilities to establish an antibiotic stewardship program by November 2017. Thus far, limited evidence describes implementation of antibiotic stewardship in long-term care 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 long-term care setting. The intent of this policy, which can be adapted by individual facilities, is to help long-term care facilities implement an antibiotic stewardship policy that will meet or exceed CMS requirements. We also briefly discuss implementation of an antibiotic stewardship program in long-term care settings, including a list of free resources to support those efforts.

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

“…29 In addition to the CDC core elements, NHs can use a number of guidelines and templates published by experts and professional organizations to build their ASP. 30,31 Additionally, Quality Innovation Networks-Quality Improvement Organizations (QIN-QIOs) have been funded by CMS to provide resources for NHs to use when developing their ASP. 32 Implementation of antibiotic stewardship faces challenges in all health care settings, 33 however, NHs are even more resource-challenged, especially in areas of staffing and infrastructure.…”

Decisional Guidance Tool for Antibiotic Prescribing in the Skilled Nursing Facility

“…Our data confirm that cultures sent from individual SNFs are inadequate to generate reliable species‐specific annual antibiograms. Pooling of organisms according to syndrome was effective in six of seven cases in increasing the isolates to acceptable levels (ie, >30) . The pooled species account for more than 85% of typical organisms associated with UTI in noncatheterized patients in SNFs.…”

“…Pooling of organisms according to syndrome was effective in six of seven cases in increasing the isolates to acceptable levels (ie, >30). 21 The pooled species account for more than 85% of typical organisms associated with UTI in noncatheterized patients in SNFs. Embedded within the proportions were the weighted incidences of each organism and associated contribution to disease in each institution.…”

“…Although the use of antibiograms as an ASP strategy is attractive in theory, multiple barriers exist in their routine implementation in SNFs. The number of clinical isolates collected annually in most SNFs are too few to calculate susceptibility estimates reliably for most bacterial species in accordance with consensus recommendations by the Clinical and Laboratory Standards Institute . Pooling isolates from multiple facilities may help overcome this problem but may result in susceptibility estimates that are not facility specific, which, in turn, may increase the risk of ineffective antibiotic treatments .…”

“…The number of clinical isolates collected annually in most SNFs are too few to calculate susceptibility estimates reliably for most bacterial species in accordance with consensus recommendations by the Clinical and Laboratory Standards Institute. 16,21,22 Pooling isolates from multiple facilities may help overcome this problem but may result in susceptibility estimates that are not facility specific, which, in turn, may increase the risk of ineffective antibiotic treatments. 23 Clinicians also report that interpretation of the data contained in a typical antibiogram is challenging and not necessarily aligned with how clinical decisions are made.…”