Antibiogram Use in Nursing Homes
According to Centers for Medicare and Medicaid Services Conditions of Participation (§483.80(a)(3)), nursing homes must establish an infection prevention and control program that includes an antibiotic stewardship program. Use of a nursing home-specific antibiogram is a tool nursing homes might consider for improving antibiotic prescribing.
The Agency for Healthcare Research and Quality defines an antibiogram as a report that displays the organisms that are present in diagnostic clinical specimens that nursing homes send for laboratory testing – aggregated across all residents suspected of having an infection during a certain time period – along with the susceptibility of each organism to various antibiotics.
Using antibiogram reports assists prescribing clinicians to make prompt, empirically based decisions.
The AHRQ toolkit, Using Nursing Home Antibiograms to Choose the Right Antibiotic, is a great resource for nursing homes interested in implementing antibiograms as a part of their comprehensive antibiotic stewardship program. According to AHRQ, there are four steps to implementing an antibiogram:
- Identify champions: Champions help drive successful implementation by increasing staff awareness of tools, building support among leadership and nursing home staff, and monitoring antibiogram results. It is helpful to have at least two champions at the nursing home to make sure that an antibiogram is created and distributed even if there is staff turnover. These champions can be the director of nursing, assistant director of nursing, administrator, charge nurses, and/or the medical director.
- Develop the antibiogram: The AHRQ toolkit provides instructions on how to create the antibiogram. You will need details about the facility’s diagnostic culture results along with the antibiotic susceptibility tests conducted on the isolated organisms. At least one year’s data are needed to create an antibiogram. This step will require collaboration with the primary laboratory from which culture results are obtained.
- Distribute the antibiogram: Antibiogram distribution should be accompanied with instructions for use and interpretation. Importantly, each nursing home is different and nursing home leadership will need to determine the best way to distribute information to prescribing clinicians and nursing home staff.
- Update the antibiogram: Updating the antibiogram annually will help maintain its value.
Included with today’s notice is an example policy on use of antibiogram and links to AHRQ resources.
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