Antibiotic Stewardship Template Guides Facilities’ Development of Mandated Programs

November 13, 2017
Perry Gwen Meyers,

Antibiotic resistance is a global health crisis. National efforts to improve the use of antibiotics include changes made by the Centers for Medicare and Medicaid services (CMS) to the Requirements of Participation for Long-Term Care Facilities, which require an antibiotic stewardship program “that includes antibiotic use protocols and a system to monitor antibiotic use.” To support successful implementation of an antibiotic stewardship program, the AMDA—The Society for Post-Acute and Long-Term Care Medicine Infection Advisory Committee developed an antibiotic stewardship policy template that individual facilities may adapt to suit their specific needs. The template is published in the November issue of JAMDA.

Template for an Antibiotic Stewardship Policy for Post-Acute and Long-Term Care” calls for the formation of a multidisciplinary antibiotic stewardship committee that includes, minimally, the director or assistant director of nursing, the medical director or designee, an infection prevention nurse or other practitioner, and a pharmacist. The authors also recommend antibiotic use protocols to provide guidance on appropriate indications for ordering diagnostic tests. For example, they say, “In LTC settings, the results of urine cultures, rather than clinical symptoms, often spurs unnecessary antibiotic use.” These protocols, say the authors, should use evidence-based guidelines to support recommendations for length of therapy when antibiotics are deemed appropriate for urinary tract infections or other conditions.

The template addresses the importance of measuring and monitoring antibiotic use, including the use of antibiograms, tables that show how susceptible a series of organisms are to different antimicrobials. These can be used to track changes in resistance patterns over time. Elsewhere, the authors say, “A system to monitor antibiotic use requires measuring and reporting antibiotic use. This, in turn, permits identification of potential goals for the antibiotic stewardship program and tracking progress toward these goals.” The authors also identify multidisciplinary education is an important aspect of implementing a successful antibiotic stewardship program in LTC facilities. The template highlights education and other resources from the U.S. Centers for Disease Control & Prevention, the Agency for Healthcare Research and Quality, and other organizations.

Robin Jump, MD, CMD, one of the template’s authors and a member of the Infection Advisory Committee, says, “We were getting many questions from Society members and others about what CMS will be expecting and what their antibiotic stewardship programs should entail. We wanted nursing homes to have a head start as the federal guidelines go into effect. The template is designed to make antibiotic stewardship more effective and comprehensive and easier to implement. We want to help facilities overcome any barriers to stewardship they may have encountered.” She hopes that the template will be shared far and wide. “It is very important to have a consistent message and for staff and practitioners to be on the same page.” She notes that this will promote effective communication between practitioners, team members, patients, and families about stewardship and dispel misconceptions about antibiotics.

The template is open access and is available here. In addition, the Society has a variety of resources on antibiotic stewardship, including archived webinars on the topic. For more information, click here. To contact the researchers or JAMDA Editor for interview contact