Collaboration Between Leaders Can Improve Antibiotic Transitions

August 22, 2023


Contact: Ellen Mullally

Transitions of care, particularly from the hospital to the nursing home, continue to pose challenges. For instance, hospitalized patients discharged to nursing homes on antibiotics are at increased risk for poor outcomes. In an article in the August issue of JAMDA, the author—Nonso Osakwe, MD, MPH, from Mount Kisco, NY—explained how hospital and nursing home leaders could collaborate to improve the management of hospital-initiating antibiotics in the nursing home by developing simple policies or practices.

In Transitioning Antibiotics from Hospitals to Nursing Homes – Bridging the Gap, Dr. Osakwe said, “Establishing effective antibiotic transition interventions demands coordinated monitoring of antibiotics in the post-acute nursing home setting to protect patients, support the nursing home infrastructure, and improve clinical outcomes from acute- to post-acute care.”

Dr. Osakwe observed that certain groups of patients are at higher risk for poor management of hospital-initiated antibiotics in the nursing home. For example, patients discharged to nursing homes on intravenous vancomycin are at increased risk for complications and poor outcomes. This is particularly true if time-sensitive monitoring of vancomycin trough levels conducted to ensure appropriate dosing is not completed as frequently as necessary.

And Dr. Osakwe further observed that the collaboration between hospital physicians and nursing homes needed to improve antibiotic transitions could provide an added clinical resource for providers and nursing staff. This approach should involve monitoring progress on antibiotic management during the transition period and prompt reconciliation of hospital-initiated antibiotics on admission to the nursing home.

“Strategies for establishing a coordinated communication infrastructure with discharging hospitals may include creating electronic discharge order sets or fixed discharge templates that contain all vital information regarding management of antibiotics,” Dr. Osakwe said, adding that establishing a transitional care parenteral antimicrobial therapy team is an “important focused approach to tackle some of the barriers in antibiotics transitioned to nursing home settings.”

Potential incentives to measure discharge antibiotics may be helpful on a policy level, according to Dr. Osakwe, who said, “Tracking discharge antibiotics from hospital to nursing homes may represent one potential approach to improve [antimicrobial stewardship] in both settings, albeit requires strong administrative support.”

Get more information on the findings above and more details about the study. To contact the researcher or JAMDA editors for an interview, please email





JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit for more information.

About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.