scholarly journals Using Antibiograms to Improve Antibiotic Prescribing in Skilled Nursing Facilities

2014 ◽  
Vol 35 (S3) ◽  
pp. S56-S61 ◽  
Author(s):  
Jon P. Furuno ◽  
Angela C. Comer ◽  
J. Kristie Johnson ◽  
Joseph H. Rosenberg ◽  
Susan L. Moore ◽  
...  
Keyword(s):  
Acute Care ◽  
Care Facility ◽  
Skilled Nursing Facilities ◽  
Initial Assessment ◽  
Antibiotic Prescribing ◽  
Nursing Facilities ◽  
Prescribing Practices ◽  
Cross Sectional ◽  
Skilled Nursing ◽  
Clinical Culture

Background.Antibiograms have effectively improved antibiotic prescribing in acute-care settings; however, their effectiveness in skilled nursing facilities (SNFs) is currently unknown.Objective.To develop SNF-specific antibiograms and identify opportunities to improve antibiotic prescribing.Design and Setting.Cross-sectional and pretest-posttest study among residents of 3 Maryland SNFs.Methods.Antibiograms were created using clinical culture data from a 6-month period in each SNF. We also used admission clinical culture data from the acute care facility primarily associated with each SNF for transferred residents. We manually collected all data from medical charts, and antibiograms were created using WHONET software. We then used a pretest-posttest study to evaluate the effectiveness of an antibiogram on changing antibiotic prescribing practices in a single SNF. Appropriate empirical antibiotic therapy was defined as an empirical antibiotic choice that sufficiently covered the infecting organism, considering antibiotic susceptibilities.Results.We reviewed 839 patient charts from SNF and acute care facilities. During the initial assessment period, 85% of initial antibiotic use in the SNFs was empirical, and thus only 15% of initial antibiotics were based on culture results. Fluoroquinolones were the most frequently used empirical antibiotics, accounting for 54.5% of initial prescribing instances. Among patients with available culture data, only 35% of empirical antibiotic prescribing was determined to be appropriate. In the single SNF in which we evaluated antibiogram effectiveness, prevalence of appropriate antibiotic prescribing increased from 32% to 45% after antibiogram implementation; however, this was not statistically significant (P = .32).Conclusions.Implementation of antibiograms may be effective in improving empirical antibiotic prescribing in SNFs.

scholarly journals Quality of Post-Acute Care in Skilled Nursing Facilities That Disproportionately Serve Black and Hispanic Patients

2018 ◽  
Vol 74 (5) ◽  
pp. 689-697 ◽  
Author(s):  
Maricruz Rivera-Hernandez ◽  
Momotazur Rahman ◽  
Dana B Mukamel ◽  
Vincent Mor ◽  
Amal N Trivedi
Keyword(s):  
Acute Care ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Hispanic Patients ◽  
Post Acute Care

scholarly journals 2045. GAIN (Generating Antimicrobial Stewardship Initiatives in Chicago Skilled Nursing Facilities) Collaborative Survey Results: CDC Core Elements of Antimicrobial Stewardship Compliance Assessment in 27 Chicago Skilled Nursing Facilities

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S687-S688 ◽  
Author(s):  
Amy P Hanson ◽  
Massimo Pacilli ◽  
Shannon N Xydis ◽  
Kelly Walblay ◽  
Stephanie R Black
Keyword(s):  
Antimicrobial Stewardship ◽  
Treatment Guideline ◽  
Skilled Nursing Facilities ◽  
Antibiotic Prescribing ◽  
Nursing Facilities ◽  
Term Care ◽  
Skilled Nursing ◽  
Core Elements ◽  
Director Of Nursing ◽  
Minimum Criteria

Abstract Background Antimicrobial Stewardship Programs (ASPs) in long-term care facilities is a Centers for Medicare and Medicaid Services requirement as of 2017. The CDC recommends that ASPs in skilled nursing facilities (SNFs) fulfill 7 Core Elements: leadership commitment, accountability, drug expertise, action, tracking, reporting and education. Methods An electronic survey utilizing REDCap was sent to the 76 Chicago SNFs representatives (Administrator, Director of Nursing, and/or Assistant Director of Nursing). Survey questions were adopted from the CDC Core Elements of Antimicrobial Stewardship for Nursing Homes Checklist. Results Twenty-seven (36%) of Chicago SNFs responded. Bed size ranged from 36 – 307 (median 150). Although 93% of facilities had a written statement of leadership support for antimicrobial stewardship, only 22% cited any budgeted financial support for antimicrobial stewardship activities. While Pharmacist Consultants visited all SNFs (most visiting monthly), only 33% of SNFs had an Infectious Disease Provider that consulted on-site. Dedicated time for antimicrobial stewardship activities was less than 10 hours per week in 78% of facilities, with half of all respondents reporting less than 5 hours per week. Treatment guidelines were in place for 63% of SNFs, 56% had an antibiogram, and only 7% utilized the Loeb criteria to guide appropriate antibiotic prescribing. Many facilities tracked antimicrobial stewardship metrics (93%) and reported out to staff (70%). Annual nursing training on antimicrobial stewardship occurs more frequently (85%) than prescriber education (56%). The top 3 barriers identified in implementing ASPs were financial limitations (33%), lack of clinical expertise (33%), and provider opposition (30%). Facilities’ compliance in all seven core elements varied from partially compliant (65%), majority compliant (19%), and majority non-compliant (16%). Conclusion Data from this baseline survey informed focused antimicrobial stewardship initiatives for the GAIN Collaborative. Targeted areas to incorporate into facility action plans include treatment guideline development, antibiograms, annual staff antimicrobial stewardship education, and adoption of the Loeb minimum criteria for antibiotic prescribing into clinical practice. Disclosures All authors: No reported disclosures.

scholarly journals A Qualitative Study of Antibiotic Stewardship Implementation at Arizona Skilled Nursing Facilities

2020 ◽  
Vol 41 (S1) ◽  
pp. s101-s101
Author(s):  
Theresa LeGros ◽  
Connor Kelley ◽  
James Romine ◽  
Katherine Ellingson
Keyword(s):  
Nursing Homes ◽  
Antibiotic Stewardship ◽  
Population Level ◽  
Skilled Nursing Facilities ◽  
Care Transition ◽  
Antibiotic Prescribing ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
The Core ◽  
Core Elements

Background: The CDC Core Elements of Antibiotic Stewardship (AS) include 7 evidence-based best practices adapted for a variety of healthcare settings, including nursing homes. We aimed to identify barriers and facilitators related to AS implementation in skilled nursing facilities (SNFs) within 18 months of the CMS mandate for AS implementation in SNFs, and to examine their relevance to the CDC’s Core Elements for Nursing Homes. Methods: We conducted 56 semistructured interviews with administrators, clinicians, and nonclinical staff at 10 SNFs in urban, suburban, rural, and border regions of Arizona. All interviews were recorded, transcribed, and imported into NVivo v12.0 software for constant comparative analysis by 3 researchers using a priori and emergent codes. After iterative coding, we confirmed high interrater reliability (κ = 0.8), finalized the code book, and used matrix coding queries to examine relationships and generate themes. Results: We identified 7 themes as “influencers” that were less (barrier) or more (facilitator) supportive of AS in SNFs. Intra- and interfacility communication were the most frequently described: respondents described stronger communication within the SNF and between the SNF and hospitals, labs, and pharmacies as critical to robust AS implementation. Other influencers included AS education, antibiotic tracking systems, SNF prescribing norms, human resources, and diagnostic resources. The Core Elements were reflected in all influencer themes except interfacility communication between SNFs and hospitals. Additionally, themes pertaining to systems emerged as critical to successful AS implementation, including the need to address: the interactions of multiple roles across the traditional SNF hierarchy, stewardship barriers from the lens of patient-level concerns (as opposed to population-level concerns), the distinction between antibiotic prescribing gatekeepers and stewardship gatekeepers, and care transition policies and practices. The Core Elements target many aspects of these systems themes—for example, they recognize the importance of creating a culture of stewardship. However, they do not address care transition policies or procedures beyond recommending that transfer-initiated antibiotics be tracked and verified. Conclusions: Because the interactions of various agents within and beyond the SNF can facilitate or inhibit stewardship in complex ways, our findings suggest the use of a systems approach to AS implementation that prioritizes communication within the SNF hierarchy, and between SNFs and hospitals, diagnostic facilities, and pharmacies. When followed, the CDC’s Core Elements can provide crucial guidance. However, SNFs need support to overcome the challenges of incorporating these elements into policy and practice. Additionally, more work is needed to understand and enhance stewardship-related care transition, which remains under-addressed by the CDC.Disclosures: NoneFunding: None

scholarly journals Utilization of Acute Care among Patients with ESRD Discharged Home from Skilled Nursing Facilities

2015 ◽  
Vol 10 (3) ◽  
pp. 428-434 ◽  
Author(s):  
Rasheeda K. Hall ◽  
Mark Toles ◽  
Mark Massing ◽  
Eric Jackson ◽  
Sharon Peacock-Hinton ◽  
...  
Keyword(s):  
Acute Care ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing

scholarly journals Expectations and Experiences with Physician Care among Patients Receiving Post-Acute Care in US Skilled Nursing Facilities

2020 ◽  
Author(s):  
Kira L Ryskina ◽  
Kierra A. Foley ◽  
Jason H. Karlawish ◽  
Joshua D. Uy ◽  
Briana Lott ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Acute Care ◽  
Nurse Practitioners ◽  
Skilled Nursing Facilities ◽  
Theory Approach ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Individualized Care ◽  
Physician Care ◽  
Post Acute Care

Abstract Background and Objectives: In the US, post-acute care in skilled nursing facilities (SNFs) is common and outcomes vary greatly across facilities. Little is known about the expectations of patients and their caregivers about physician care during the hospital to SNF transition. Our objectives were to (1) describe the experiences and expectations of patients and their caregivers with SNF physicians (or advanced practitioners such as nurse practitioners) in SNFs, and (2) identify patterns that differed between patients with vs. without cognitive impairment.Research Design and Methods: This qualitative study used grounded theory approach to analyze data collected from semi-structured interviews at five SNFs in January-August 2018. Patients admitted for short-term SNF care 5-10 days prior were eligible to participate. Thematic analysis was performed to detect recurrent themes with a focus on modifiable aspects of physician care. Analysis was stratified by patient cognitive impairment (measured by the Montreal Cognitive Assessment at the time of the interview). Results: Fifty patients and six caregivers were interviewed. Major themes were: (1) patients had poor awareness of the physician in charge of their care; (2) they were dissatisfied with the frequency of interaction with the physician; and (3) participants valued the perception of receiving individualized care from the physician. Less cognitively impaired patients were more concerned about limited interactions with the clinicians and were more likely to report attempts to seek out the physician. Discussion and Implications: Patient and caregiver expectations of SNF physicians were not well aligned with their experiences. SNFs aiming to improve satisfaction with care may focus efforts in this area, such as facilitating frequent communication between physicians, patients and caregivers.

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