Core Elements of Antibiotic Stewardship for Nursing Homes
Antibiotic stewardship refers to a set of commitments and actions designed to “optimize the treatment of infections while reducing the adverse events associated with antibiotic use.” The Centers for Disease Control and Prevention (CDC) recommends that all acute care hospitals implement an antibiotic stewardship program (ASP) and outlined the seven core elements which are necessary for implementing successful ASPs. CDC also recommends that all nursing homes take steps to improve antibiotic prescribing practices and reduce inappropriate use.
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. These harms 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.
This document adapts the CDC Core Elements of Hospital Antibiotic Stewardship into practical ways to initiate or expand antibiotic stewardship activities in nursing homes. While the elements are the same for both hospitals and nursing homes, the implementation of these elements may vary based on facility staffing and resources. Nursing homes are encouraged to work in a step-wise fashion, implementing one or two activities to start and gradually adding new strategies from each element over time. Any action taken to improve antibiotic use is expected to reduce adverse events, prevent emergence of resistance, and lead to better outcomes for residents in this setting.
To assist Long Term Care providers in their goals for the appropriate use of antibiotics, the CDC released the Core Elements of Antibiotic Stewardship for Nursing Homes in 2015. This guide offers practical strategies for applying the seven Core Elements in nursing homes. Nursing homes are encouraged to work in a step-wise fashion, implementing one or two activities to start and gradually adding new strategies from each element over time.
The Seven Core Elements of Antibiotic Stewardship for Nursing Homes include:
Accountability: To ensure success of the program, nursing homes will identify individuals who will be accountable for the Antibiotic Stewardship activities. These individuals will have the support of the facility leadership. Important roles that will be empowered are the Medical Director, who will set standards for antibiotic prescribing practices, the Director of Nursing, who will set into practice the standards for assessment, monitoring and communicating critical patient changes, and the Consultant Pharmacist, who will provide oversight through quality assurance activities. Other key roles include the Infection Prevention Program Coordinator, the Consultant Laboratory, and state and local health departments.
Drug Expertise: Gaining support from individuals that have antibiotic expertise will assist the nursing home in implementing antibiotic stewardship programs. Working with the Consultant Pharmacist, partnering with the hospitals in your area, and developing relationships with infectious disease consultants in your community are all examples of establishing antibiotic expertise.
Action: Policy and procedure should be revised to reflect prescribing policies and change practices for antibiotic use. It is important that a new policy and procedure is rolled out gradually, to avoid overwhelming staff with new changes in practice. The Core Elements of Antibiotic Stewardship for Nursing Homes, Appendix A includes practical tips to implement changes in policy and practice.
Tracking: Tracking data about antibiotic use practices and outcomes related to antibiotics will be critical in measuring the success of the new policy and procedure.
Reporting: Process measures, use measures, and outcome measures should be utilized to report the results of new practices. The Core Elements of Antibiotic Stewardship for Nursing Homes, Appendix B includes examples of measures that can be used to measure prescribing, use, and outcomes of antibiotic use.
Education: Nurses, residents and families will require education about the goals of antibiotic stewardship intervention and the responsibility of each group for ensuring its implementation. Nursing can learn how to document the clinical symptoms of an infection to decrease the use of antibiotics for asymptomatic bacteremia.
The Core Elements of Antibiotic Stewardship for Nursing Homes adapts the CDC Core Elements of Hospital Antibiotic Stewardship into practical ways to initiate or expand antibiotic stewardship activities in nursing homes. Nursing homes are encouraged to work in a step-wise fashion, implementing one or two activities to start and gradually adding new strategies from each element over time. Any action taken to improve antibiotic use is expected to reduce adverse events, prevent emergence of resistance, and lead to better outcomes for residents in this setting.
To see the original information from the CDC website and visit to download the related PDF checklists and brochures, Click Here
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