What is Antibiotic Stewardship?
It is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multi drug-resistant organisms.
Mega Rule Phase 2
As part of the new Mega Rule Phase 2 of implementation and the overhaul of the conditions of participation, skilled nursing facilities must implement an Antibiotic Stewardship Program by November 28th, 2017, including the addition of an Infection Preventionist by November 28th, 2019.
Antibiotic Stewardship guidelines were developed because of the overuse of antibiotic in nursing homes. Up to 70% of nursing home residents receive antibiotics each year and 75% of antibiotics prescribed were unnecessary*. Overprescribing broad-spectrum antibiotics can destroy the good bacteria and highly resistant bacteria can lead to costly hospital readmissions.
There are 7 Core Elements in developing an Antibiotic Stewardship Program:
1. Leadership commitment – Centers must demonstrate support and commitment to a safe and appropriate antibiotic use at the center. This may include dedicating necessary human, financial and information technology resources. Formal written statements that support the centers efforts to improve and monitor antibiotic use, job duties in position descriptions and annual performance reviews, sufficient time for staff to contribute to antibiotic stewardship activities, support training and education and ensure participation from groups.
2. Accountability – Centers must identify an Antibiotic Stewardship Leader, including empowering the Medical Director, Director of Nursing and the Pharmacist to set standards for antibiotic prescribing, assessing, monitoring and communicating changes in resident’s condition, quality assurance activities, medication regimen review and reporting of antibiotic use data.
3. Drug expertise – Centers must establish access to consultant pharmacists and other individuals with expertise in Antibiotic management in participating in antibiotic stewardship activities. Centers may want to partner with antibiotic stewardship program leads at the hospitals within their referral network or develop relationships with infectious disease consultants in their community.
4. Action – Centers must establish 1 written policy and procedure to improve antibiotic use including optimal antibiotic use, broad interventions and standardization of practices for those suspected of an infection and integration of the dispensing of antibiotics and consultant pharmacist into the clinical care team.
5. Tracking and 6. Reporting – Centers must monitor one process measure of antibiotic use. How and why the antibiotics are prescribed including reviews of resident medical records for new antibiotics. The center must also monitor at least one outcomes from Antibiotic use in the center, tracking how often and how many antibiotics are prescribed. Centers must provide regular feedback on antibiotic use and resistance to prescribing clinicians, nursing staff and other relevant staff.
7. Education – Centers must provide resources by way of flyers, pocket-guides, newsletters or electronic communication to clinicians, nursing staff, residents, and families about antibiotic resistant opportunities for improving antibiotic use. Centers can sustain improvements by incorporating both education and feedback to providers.
– Denise Ogden, LNHA, BSW
To read more about the Antibiotic Stewardship guidelines, visit the CDC website, here.
To read more about how COMS can help you provide person-centered care, as part of the Mega Rule, click here.