The CDC turns its attention to incorrect use of antibiotics in nursing homes.
Nearly 1.4 million Americans are admitted to – or reside in – nursing homes annually, according to the Centers for Disease Control and Prevention (CDC). Each year, about 70 percent of these residents receive one or more courses of antibiotics – 40-70 percent of which are reported incorrectly prescribed. Either the drug was given unnecessarily, or the prescription was for the wrong drug or dose.
“Harms from antibiotic overuse are significant for the frail and older adults receiving care in nursing homes,” says the CDC in its new resource, The Core Elements of Antibiotic Stewardship for Nursing Homes. “These harms include risk of serious diarrheal infections from Clostridium difficile, increased adverse drug events and drug interactions, and colonization and/or infection with antibiotic-resistant organisms.” The new Core Elements build on last year’s recommendations that all acute care hospitals implement an antibiotic stewardship program designed to optimize treatment of infection, while reducing adverse events associated with antibiotic use.
The Core Elements offer practical ways for nursing homes to initiate or expand antibiotic stewardship activities, says the CDC. The resource offers examples of how antibiotic use can be monitored and improved by nursing home leadership and staff. Included is a checklist designed to assess policies and practices already in place, as well as review progress in expanding stewardship activities on a regular basis.
The CDC recognizes that, depending on the resources they have, nursing homes will require different time allotments for implementing antibiotic protections. The goal, however, is for all nursing homes to develop antibiotic protocols that – at a minimum – include the following:
- Leadership commitment. Demonstrate support and commitment to safe and appropriate antibiotic use.
- Identify leaders who are responsible for promoting and overseeing antibiotic stewardship activities at the nursing home. The CDC recommends appointing a single leader, such as a physician, to be responsible for program outcomes. A pharmacy leader should be identified to co-lead the program. Clinicians, infection prevention professionals, epidemiologists, laboratory staff, information technology staff and nurses all can support and enhance the program.
- Drug expertise. Establish access to experts with experience or training in improving antibiotic use.
- Take at least one new action to improve the way antibiotics are used in the facility.
- Measure how antibiotics are used and the complications (e.g., C. difficile infections) from antibiotics in the facility. Measurement is necessary to identify opportunities for improvement and assess the impact of improvement efforts.
- Share information with healthcare providers and staff about how antibiotics are used in the facility.
- Provide resources to healthcare providers, nursing staff, residents and families to learn about antibiotic resistance and opportunities for improving antibiotic use.
Leadership support is essential to the success of antibiotic stewardship programs, notes the CDC. It can include a number of forms, such as:
- Formal statements that the facility supports efforts to improve and monitor antibiotic use.
- Stewardship-related duties stated in job descriptions and annual performance reviews.
- Sufficient time allotted to staff working to contribute to stewardship activities.
- Training and education.
- Oversight to ensure participation in stewardship activities.
The more a facility invests in an antibiotic stewardship program, the more successful it’s likely to be. At the same time, “stewardship programs will often pay for themselves, through savings in both antibiotic expenditures and indirect costs,” says the CDC.
Strategies for improving antibiotic use and evidence for best practices in antibiotic stewardship are constantly evolving, notes the CDC. Facilities will continue to see the integration of IT specialists into the clinical data presentation and decision making for antibiotic use, particularly as electronic health records continue to take hold, it predicts. At the same time, the role of lab testing will expand as rapid diagnostic tests, such as procalcitonin, fluorescence in situ hybridization using peptide nucleic acid probes (PNA FISH), and matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) mass spectrometric analysis, become increasingly important to stewardship efforts. Indeed, as more facilities engage in efforts to optimize antibiotic use, future work will be needed to evaluate which interventions or antibiotic targets yield the greatest benefit in combating antibiotic resistance, says the CDC.
Source: http://www.cdc.gov/longtermcare/prevention/antibiotic-stewardship.html.