Prior to the publication of CMS’ final rule on October 4, 2016, which heavily revised many Conditions of Participation (CoP) for Medicare, the agency’s infection control regulation included language about preventing the threat of multi-drug-resistant organisms and creating strategies for effective review of antibiotic use in long-term care facilities to avoid negative, sometimes deadly, effects of resistance. Now, this revised section of the rule addresses antibiotic stewardship efforts directly, and requires providers to take a more targeted approach.
The Centers for Disease Control (CDC) report that roughly 40–50% of antibiotics are prescribed incorrectly, with the possibility of nearly 50% of antibiotics given for too long in nursing homes. These numbers highlight the shortfalls that may exist in long-term care staff education when it comes to antibiotic usage.
Experts advise staff to ask themselves what else they’ve tried prior to administering an antibiotic. One tool that can be used to determine whether antibiotics are warranted is McGeer’s criteria, which outlines criteria for infections. This tool is especially helpful in diagnosing urinary tract infections (UTI), which are often misdiagnosed due to bacteria found in residents’ urine as a result of the technique used to collect the urine, for example, rather than the presence of an actual infection. If an infection is in fact present, staff should consult with the medical director or physician staff to determine if an alternative method should be tried before antibiotics are administered, such as cranberry juice or fluids.
Education also needs to be a collaborative effort. According to the CDC, “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.” The agency names numerous forms for communicating education to staff, including flyers, pocket guides, newsletters, or electronic communications. The most effective method for improving medication prescribing practices, however, is found to be an interactive approach, such as a face-to-face workshop.
The CDC also report that 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. 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.