Statewide Initiative Improves Stewardship in Nebraska Long-Term Care Facilities


Long-term care facilities participating in a statewide initiative in Nebraska saw improvements in antimicrobial stewardship, including drops in antibiotic starts and C diff infections.

Partnering with experts in infectious diseases can help long-term care facilities (LTCF) implement effective antimicrobial stewardship programs (ASP), according to an IDWeek 2019 poster presentation.

The study examined the Nebraska Antimicrobial Stewardship Assessment and Promotion Program (ASAP), a statewide initiative funded by a grant from the US Centers for Disease Control and Prevention.

“For long-term care facilities that are struggling to implement ASPs or struggling to improve antimicrobial use, partnering with experts with infectious diseases and/or antimicrobial stewardship training to support ASP implementation can help overcome that barrier,” Philip Chung, community network pharmacy coordinator for Nebraska Antimicrobial Stewardship Assessment and Promotion Program at Nebraska Medicine, told Contagion®.

Investigators at Nebraska Medicine, the University of Nebraska Medical Center, and the Nebraska Department of Health and Human Services evaluated 5 LTCFs in 2017 and provided site-specific recommendations for ASPs. Team members followed up and supported the progress over 12 months. LTCFs were evaluated based on their implementation of recommendations and their performance in relation to core elements of ASP detailed by the CDC.

Results of the study found that implementation of CDC core elements increased during the program. None of the facilities met all 7 elements at the onset of the program. At the end of the program, 2 facilities met all of the elements and the remaining 3 were deficient only in reporting ASP metrics to providers and staff.

Challenges to implementing ASPs including staffing considerations.

“There is frequent turnover in the facility lead in ASP, which is typically an infection preventionist,” Chung said. “In addition, consultant pharmacists typically only review antimicrobial therapy that are ongoing during their monthly onsite drug regimen review.”

ASAP team members offered 38 recommendations, with 82% being implemented or started within 12 months. Antibiotic starts fell by 19% and days of antibiotic therapy decreased by 21%. Incidences of facility-onset Clostridioides difficile also fell from 0.53 to 0.13 per 10,000 resident-days.

“Implementation of ASP in LTCF to improve antimicrobial use, patient safety and outcome is a team effort that requires the involvement of medical directors, directors of nursing, infection preventionists, and consultant pharmacists,” Chung said. “LTCF that are struggling to implement antimicrobial stewardship program should seek assistance from experts with training or experience in this area.”

The abstract, “An Assessment and Feedback Model Bringing Antimicrobial Stewardship Program Expertise to Long-Term Care Facilities,” was set to be presented in a poster session on Saturday, October 5, 2019, at IDWeek 2019 in Washington DC.

Chung also was scheduled to present “Action: A year in the lives of consultant pharmacists working on antimicrobial stewardship in long-term care facilities” Saturday. This study examined the use of antimicrobial therapy in 23 LTCFs and found that 41% of therapy was determined to be inappropriate. ASPs have been a challenge and focus for LTCFs in recent years. The Centers for Medicare & Medicaid Services issued a mandate in October 2016 stating that all LTCFs must fully implement an ASP by November 2019. That mandate has sparked initiatives, including the Optimizing Antibiotic Stewardship in Skilled nursing facilities (OASIS) intervention. That study also saw drops in day of antibiotic therapy.

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