Educating Nursing Home Staff about Antibiotic Stewardship

PUBLISHED: Feb 15, 2017

According to the Centers for Medicare and Medicaid Services, antibiotics are among the most frequently prescribed medications in nursing homes, with up to 70% of residents in a nursing home receiving one or more courses of systemic antibiotics when followed over a year. Similar to the findings in hospitals, studies have shown that 40–75% of antibiotics prescribed in nursing homes may be unnecessary or inappropriate.

Harms from antibiotic overuse are significant for the frail and older adults receiving care in nursing homes and 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 Centers for Medicare and Medicaid Services requires nursing homes to establish and maintain an infection prevention and control program that includes an antibiotic stewardship program that uses antibiotic use protocols and a system to monitor antibiotic use (§483.80(a)(3)). Education of staff about antibiotic stewardship is a core element of a comprehensive antibiotic stewardship program.

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. There are a variety of mechanisms for disseminating antibiotic education to nursing home staff including flyers, pocket-guides, newsletters or electronic communications; however, interactive academic detailing (e.g., face-to-face interactive workshops) has the strongest evidence for improving medication prescribing practices.

Case Studies:

  • One nursing home antibiotic stewardship intervention demonstrated a sustained reduction in antibiotic use for two years after the intervention by linking education with feedback on physician prescribing practices. (CDC, 2015)
  • Another study showed a 64% reduction in inappropriate antibiotic use (i.e., prescriptions which did not adhere to guidelines), by providing feedback on individual physician prescribing practices and adherence to the guidelines over 12 months. (CDC, 2015)
  • Studies show that use of an antibiogram in nursing homes can decrease antibiotic prescribing. (AHRQ, June 2012)

Every nursing home should have a policy that addresses educating staff about antibiotic stewardship. At a minimum an education plan policy should include:

  • That the facility provides antibiotic stewardship education to staff, clinicians, residents and families
  • Who is responsible for providing the education
  • The frequency of education
  • Documentation requirements

Included with today’s notice is an example antibiotic stewardship education plan.

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