How to improve antibiotic management programs in nursing homes

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In research presented virtually at IDWeek 2021, researchers from the Centers for Disease Control and Prevention (CDC) conducted a citation gap review for antibiotic management in nursing homes to improve implementation. artwork.

Here, presenting author Katryna Gouin, MPH, Scientific Data Analyst at CDC’s Bureau of Antibiotics Management, details in a Q&A email the key takeaways and clinical importance of the review.

Question: Why are nursing homes a prime target on which to focus antibiotic management efforts?

Reply: Residents of nursing homes are at high risk of infection and adverse events associated with the use of antibiotics, including colonization and infection with antibiotic resistant organisms and Clostridioides difficile. It is estimated that 50-70% of nursing home residents will be prescribed 1

or several courses of systemic antibiotics in one year. Optimizing the prescription of antibiotics in nursing homes is crucial in reducing the risk of adverse events due to the use of unnecessary or inappropriate antibiotics. The Centers for Medicare & Medicaid Services (CMS) recognize the importance of appropriate antibiotic use in this context and require that antibiotic stewardship programs be implemented in nursing homes. The CMS requirements stress that nursing homes should develop and implement antibiotic use protocols and an antibiotic use monitoring system.

Question: Can you summarize the main findings of the citations review?

Reply: In our analysis, we conducted a quantitative and qualitative review of the citation gaps in the management of antibiotics dispensed to nursing homes between September 2018 and July 2019 in 44 states. We found that the 631 nursing homes that received an antibiotic management deficiency citation were more likely to be for-profit or to have a small bed size (≤ 99) compared to the 14,841 nursing homes that had not received a citation. After reviewing 318 randomly selected citation texts, we categorized the citations into 1 or more of 4 major categories based on the basics of antibiotic management for CDC nursing homes.

Deficiencies action related to antibiotic prescribing was the most common citation (67%), identified either by missing antibiotic prescribing protocols or by missing documentation of criteria for antibiotic initiation, reassessment or review upon admission or readmission to a retirement home. Antibiotic deficiencies Monitoring and reporting accounted for 40% of citations, in which nursing homes were frequently cited for missing or incomplete antibiotic or infection surveillance records. Deficiencies Leadership and responsibility were identified in 23% of stewardship citations, generally as the lack of an antibiotic stewardship policy available at the facility. Deficiencies Education, in which investigators identified that healthcare professionals lacked appropriate training in antibiotic management, accounted for 13% of citations.

Question: Have there been any notable trends among nursing homes with a high number of citations?

Reply: Differences in the number of core item categories cited by nursing home may be related to investigator variability and different reporting requirements by state and region. We limited this analysis to citations of antibiotic management and did not assess other types of citation deficiencies in nursing homes. Future assessments of infection prevention and control citation gaps as well as antibiotic management citations could help identify nursing homes that need additional support to implement treatment programs. management and prevention and control of infections.

Question: What are the ways to improve the implementation of antibiotic management in nursing homes?

Reply: There are several barriers to implementing antibiotic management in nursing homes, including limited expertise in antibiotic management, high rates of staff turnover in this setting, and high medical complexity of residents. .

We have identified concrete opportunities to improve the implementation of the antibiotic stewardship program in nursing homes, including:

  • All facilities should have an antibiotic stewardship policy that demonstrates commitment to program goals, responsible roles, and actions taken to implement antibiotic stewardship.
  • Establishments should implement antibiotic use protocols, which was one of the most common reasons for antibiotic management citations. Protocols requiring documentation of antibiotic initiation and re-evaluation criteria should be integrated into nursing home workflows to improve adherence.

Nursing home staff should receive training in antibiotic management to implement facility policy and prescribing protocols.

This assessment also highlighted that additional resources are needed to help nursing homes have an antibiotic use monitoring system, as required by CMS regulations, including:

  • Antibiotic use tracking and reporting resources – ideally, facility level antibiotic use tracking should be automated using electronic health records or dispensing data from care pharmacies long-term, since manual antibiotic monitoring is time consuming.
  • Training resources for nursing home health professionals to interpret data on antibiotic use and identify areas where further assessment is needed and opportunities for improvement exist.

The study, “Review of Citation Deficiencies of Antibiotic Management in Nursing Homes to Identify Opportunities for Improving Antibiotic Management Implementation, 2018-2019,” was presented virtually at the ‘IDWeek 2021, held from September 29 to October 3, 2021.

This article originally appeared in Contagion®.

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