New recommendations from the Centers for Disease Control and Prevention (CDC) advise all nursing homes to improve antibiotic prescribing practices and reduce their inappropriate use to protect residents from the consequences of antibiotic-resistant infections. These recommendations expand upon CDC’ s recommendation last year that all acute care hospitals implement an antibiotic stewardship program designed to optimize treatment of infections while reducing adverse events associated with antibiotic use. Inappropriate and unnecessary antimicrobial usage leads to an increase in healthcare costs and pathogen resistance.

OCH has joined the Hospital Association of New York State’s (HANYS) Antibiotic Stewardship Collaborative, a program that supports the implementation and enhancement of antibiotic stewardship programs at participating hospitals. This initiative includes ongoing education on best practices and data collection and analysis designed to improve patient care and outcomes, reduce costs, and prepare hospitals to comply with anticipated future mandates. Data is being collected from all participating hospitals to compare outcomes.

An antibiotic stewardship program uses protocols and antibiotic monitoring as part of infection prevention and control programs. They have been developed to limit unnecessary antimicrobial use through reassessment of diagnosis and therapy within 48 to 72 hours, streamlining and reducing use of antibiotics based on laboratory data, and using antibiotics for the shortest time needed. The goal is to decrease unnecessary or inappropriate antibiotic use by ensuring that the right antibiotics are prescribed at the right dose for the right length of time.

OCH has formed a multidisciplinary clinical care team for its antibiotic stewardship program, led by Pharmacy Director Kate Brauen. The initial focus for our nursing home residents is on antibiotic use for urinary tract infections. Elderly residents have more bacteria in the bladder, and may have unusual symptoms that cultures show may not necessarily be an infection.

For our hospital inpatients, the initial focus is on switching from intravenous antibiotics to oral medications. Studies show that many hospitalized patients initially on intravenous antibiotics can be safely switched to an oral equivalent within the third day of admission once clinical stability is established. This change has many advantages, such as fewer complications, less healthcare costs and earlier hospital discharge.

The OCH Clinical Staff Pharmacists are working in collaboration with nursing and physicians both in the nursing home and inpatient areas to provide effective antimicrobial therapy to each patient. Antibiotic drug information software developed by Johns Hopkins Hospital is being used as a resource in OCH’s antibiotic review protocol for ensuring antibiotics are ordered appropriately, reviewing culture data, and developing antibiotic monitoring and infection management guidance.

“I am thrilled to be a part of this program,” said Kate Brauen. “We are in the forefront of providing evidenced based, best practice care for our nursing home residents and hospital patients. The collaboration among nursing, clinical departments, administration and the medical staff has been wonderful. Only great teamwork can make a program like this successful.”