Core Elements for Hospitals
Antibiotics have transformed the practice of medicine, making once lethal infections readily treatable and making other medical advances, like cancer chemotherapy and organ transplants, possible. Prompt initiation of antibiotics to treat infections reduces morbidity and save lives, for example, in cases of sepsis. However, according to recent CDC data, about 30% of all antibiotics prescribed in U.S. acute care hospitals are either unnecessary or suboptimal, despite 92% of Kentucky hospitals reporting implementation of CDC Core Elements.
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Core Elements for LTC
Antibiotics are among the most frequently prescribed medications in nursing homes. In 2015, the Centers for Disease Control and Prevention (CDC) released the Core Elements of Antibiotic Stewardship for Nursing Homes to provide a framework for stewardship implementation. In 2016, the Centers for Medicare and Medicaid Services (CMS) issued a new antibiotic stewardship requirement for nursing home stewardship activities, which included developing antibiotic use protocols and systems for monitoring use.
Hospital Leadership Commitment
Senior leadership demonstrates support and commitment to safe and appropriate antibiotic use within the facility. These look like dedicate, necessary human, financial, and information technology resources are readily available for the antimicrobial stewardship team to access and utilize.
Nursing Home Leadership Commitment
Nursing home leaders commit to improving antibiotic use. Facility leadership, both owners and administrators, as well as regional and national leaders if the facility is part of a larger corporation, can demonstrate their support in many ways such as written commitment statement, communication, and creating an improvement culture.
Hospital Accountability
Hospitals appoint a leader or co-leaders, such as a physician and pharmacist, that work in concert with each other and are responsible for program management and outcomes.
Nursing Home Accountability
Nursing homes identify individuals accountable for the antibiotic stewardship activities who have the support of facility leadership. Support can look like: empowering the medical director to set the standard for antibiotic prescribing, empowering the director of nursing to set practice standards for monitoring and assessing, and engagement of consult pharmacist.
Hospital Pharmacy Expertise
Formerly named “drug expertise,” pharmacy expertise specifically calls to appoint a pharmacist, ideally the leader or co-leader of the stewardship program, to help lead implementation efforts to improve antibiotic use throughout the facility.
Nursing Home Drug Expertise
Nursing homes establish access to individuals with antibiotic expertise to implement antibiotic stewardship activities. Receiving support from infectious disease consultants and consultant pharmacists with training in antibiotic stewardship can help a nursing home reduce antibiotic use and experience lower rates of positive C. difficile tests. Examples of establishing antibiotic expertise include partnering with antibiotic stewardship program such as KASIC.
Hospital Action
Implement interventions, such as prospective audit and feedback or
preauthorization, to improve antibiotic use.
Nursing Home Action
Nursing homes implement prescribing policies and change practices to improve antibiotic use. The introduction of new policies and procedures which address antibiotic use should be done in a step-wise fashion so staff become familiar with and not overwhelmed by new changes in practice. Prioritize interventions
based on the needs of your facility and share outcomes from successful interventions with nursing staff and clinical providers. Below are brief descriptions of policy and practice changes.
Hospital Tracking and Reporting
The Antimicrobial Stewardship Program will monitor antibiotic prescribing, impact of interventions, and other important outcomes, like C. difficile infections and resistance patterns and report them through appropriate channels, such as medical committees.
The Antimicrobial Stewardship program will regularly report information on antibiotic use and resistance to prescribers, pharmacists, nurses, and hospital leadership, and regulatory bodies where appropriate.
Nursing Home Tracking Antibiotic Use and Outcomes
Nursing homes monitor both antibiotic use practices and outcomes related to antibiotics in order to guide practice changes and track the impact of new interventions. Data on adherence to antibiotic prescribing policies and antibiotic use are shared with clinicians and nurses to maintain awareness about the progress being made in antibiotic stewardship. Clinician response to antibiotic use feedback (e.g., acceptance) may help determine whether feedback is effective in changing prescribing behaviors. Below are examples of antibiotic use and outcome measures.
Hospital Education
The Antimicrobial Stewardship Program will educate prescribers, pharmacists, nurses, and patients about adverse reactions from antibiotics, antibiotic resistance, and optimal prescribing.
Nursing Home Education
Nursing homes provide antibiotic stewardship
education to clinicians, nursing staff, residents and families. Effective educational programs address both nursing staff and clinical providers on the goal of an antibiotic stewardship intervention, and the responsibility of each group for ensuring its implementation.