2 Decreasing Antibiotics in Nursing Homes Student’s Name Institution Instructor’s Name Course

2

Decreasing Antibiotics in Nursing Homes

Student’s Name

Institution

Instructor’s Name

Course

Date of Submission

Antibiotic stewardship in nursing homes is a vital aspect of healthcare management, especially when it comes to combating urinary tract infections (UTIs) among residents. Reducing UTIs, which are associated with antibiotic-resistant organisms/pathogens, improves residents’ outcomes and quality of life, ensuring their safety and promoting the effective use of healthcare resources (Morris & Cerceo, 2020). For nursing homes to achieve this, there should be more education, proper interventions, early detection, monitoring, screening, and training for the nursing staff to create awareness of preventive measures. Here, the concept of antibiotic stewardship plays a vital role in preventing UTIs and decreasing the use of Antibiotics in nursing home environments.

In my practicum location, I have observed the essential role of quality assurance nurses collaborating with interdisciplinary teams to oversee and execute quality improvement initiatives. Collaboration with the disciplinary team is necessary and vital for implementing evidence-based practices and improving antibiotic stewardship in long-term care and can improve resident safety (Adre et al., 2020). While antibiotic stewardship is essential in nursing homes, implementing it appropriately is hindered by high turnover rates among nurses and staff in nursing homes. Inadequate staff hampers evaluation, monitoring, and treatment for UTIs, contributing to the prevalence of infections among long-term care residents (Wimmer, 2023). Nursing homes need to confront these challenges to promote the effectiveness of antibiotic stewardship initiatives.

The geriatric population is prone to UTIs and has been noted to be a common problem in long-term care facilities, possibly due to underlying health conditions, age-related changes in the urinary tract, indwelling catheters, and immobility problems (Schweiger et al., 2020). If left untreated, UTIs have the potential to escalate into life-threatening complications such as sepsis. Other complications like dehydration and prolonged hospitalization increase the burden on the healthcare system and increase healthcare expenditure. The Centers for Disease Control and Prevention (CDC) clarifies that UTIs account for almost 25% of all infections among nursing home residents (Schweiger et al., 2020). Nursing homes are, therefore, required to employ measures that reduce incidences of UTIs as a crucial step towards improving residents’ well-being while in the facility.

Antibiotic stewardship initiatives play a vital role in combating/preventing UTIs among old people in nursing homes. These initiatives entail the effort to determine and enhance the prescription of antibiotics and how the patient utilizes them to treat infections, mitigate antibiotic resistance, and safeguard patients from adverse events linked to antibiotic use (CDC, 2021). In nursing homes, antibiotic stewardship programs are critical because antibiotics are extensively used, with around 70% of residents having been prescribed this medication within a year. Unfortunately, 40% to 75% of antibiotics prescribed/consumed in these facilities are inappropriate or unnecessary, contributing to severe diarrheal infections, adverse drug interactions and events, and infection/colonization by antibiotic-resistant organisms (CDC, 2021). In this case, antibiotic utilization in such facilities is attributed to prolonged hospitalization, risk of treatment failures, mortality, and increased costs (Morris & Cerceo, 2020). These adverse effects of high use and inappropriate antibiotic prescription are detrimental to the outcomes, care, and well-being of the elderly population in nursing homes.

Antibiotic stewardship interventions entail different strategies to ensure they align with the right drug, dose, diagnosis, de-escalation, and duration. These strategies involve urine cultures, support systems for computerized decisions, provider/staff education, and urine culture result reporting. In diagnostic stewardship, delayed processing of urine culture helps hold cultures for a maximum of 48 hours prior to processing and ensures process cultures only apply when providers request or are clinically required (Goebel et al., 2021). This helps minimize unnecessary urine cultures and prescribing antibiotics to patients. Appropriate urine culture collection through offering patients cleansing instructions and procedures and utilizing straight catheterization minimizes contamination, leading to reduced false positives (Goebel et al., 2021). In this case, the providers should avoid obtaining urine cultures when individuals do not have symptoms or signs of UTI and the patient is undergoing surgery unrelated to the urinary system. These strategies help reduce unnecessary or positive urine cultures that lead to inappropriate antibiotics.

Other important strategies for improving antibiotic stewardship interventions include discerning and cascade reporting and post-prescription culture review. Selective reporting allows healthcare providers to choose the right drugs by limiting the number and type of susceptibility outcomes provided in culture reports, decreasing the utilization of broad-spectrum agents (Goebel et al., 2021). Post-prescription culture review allows providers or pharmacists to review culture results and adjust the treatment plan accordingly to correct drug-bug mismatch and increase the chances of decreasing treatment failure (Goebel et al., 2021). Besides, post-prescription culture review allows for the narrowing of antibiotics with respect to culture outcomes and stopping antibiotics if urine culture results are negative, decreasing unnecessary antibiotics (Goebel et al., 2021). These interventions empower healthcare providers or pharmacists to make sound decisions regarding antibiotic prescription and promote the judicious use of antimicrobial agents.

As indicated earlier, staffing shortage in nursing homes has a negative impact on antibiotic stewardship initiatives by reducing the quality of care offered to residents and worsening the capacity to prevent and manage UTIs. Staff shortage denies providers sufficient time, leading to delayed assessments, poor monitoring of urinary symptoms, and inadequate communication in the working environment. Providers in nursing homes that have inadequate staff feel overwhelmed by antibiotic stewardship duties because of the limited time to champion these duties (Seshadri et al., 2020). Providers usually feel restricted in promoting or exercising stewardship, improving resident care, and participating in ongoing training and education on antibiotic stewardship principles during staffing shortages (Seshadri et al., 2020). The situation requires nursing homes to emphasize antibiotic stewardship initiatives, encourage providers to meet their stewardship responsibilities, and prioritize the residents’ well-being and health.

A critical approach to help stimulate antibiotic stewardship when nursing homes are facing staffing shortages is the need to offer staff education on infection control measures and stewardship. Frontline healthcare workers require relevant skills and competence to practice antibiotic stewardship and prevent, detect, and manage UTIs in nursing homes. Equipping clinical providers and nursing staff with these skills and knowledge to utilize antibiotic stewardship interventions necessitates effective educational approaches (CDC, 2021). Self-guided education and case-based audits incorporating feedback provide an essential foundation of antibiotic stewardship by successfully minimizing urine culture ordering and infection overtreatment in long-term care settings (Goebel et al., 2021). Incorporating feedback in education programs leads to a 64 percent drop in inappropriate/unnecessary antibiotic use (CDC, 2021). Antibiotic education can be disseminated to staff in nursing homes through various methods, including pocket guides, flyers, electronic communications, and/or newsletters (CDC, 2021). These educational programs are important in helping nursing home clinicians gain the necessary knowledge and skills to make appropriate decisions on antibiotic prescription and use.

Integrating innovative tech computerized decision support systems (CDSS) provides an opportunity to improve antibiotic stewardship through automation in long-term care environments. CDSS tools entail knowledge-based systems that offer evidence-based clinical recommendations to healthcare professionals, aiding them in making informed decisions when prescribing antibiotics (Goebel et al., 2021). Healthcare facilities are implementing CDSS directly where patient care is provided to allow clinicians to merge their expertise with recommendations or information that the CDSS provides. In the contemporary digital era, CDSS tools are developed with the capacity to harness data and observations that humans cannot access or interpret. Today, healthcare facilities directly integrate CDSS into electronic health records (EHRs) to potentially enhance the utilization of antibiotics by offering prescribers instantaneous recommendations and alerts, improving prescribing decisions (Catho et al., 2020). CDSS has automated capabilities that help minimize antibiotic misuse/overuse by equipping providers with the competence to promote smarter antibiotic use and alternative treatments.

As elucidated above, in nursing homes with inadequate staffing, antibiotic stewardship is an integral ingredient for healthcare management, particularly in reducing UTIs among residents. Nursing homes embrace antibiotic stewardship initiatives to enhance residents’ outcomes and quality of life while promoting the effective use of healthcare resources by reducing the prevalence of infections linked to antibiotic-resistant pathogens. The successful implementation of antibiotic stewardship initiatives depends on various factors, including provider education, proper interventions, early detection, and staffing adequacy. Collaboration with interdisciplinary teams, quality assurance measures, and staff education are vital in fostering evidence-based practices and improving resident safety. Leveraging technological advancements like CDSS offers opportunities to automate antibiotic stewardship efforts and optimize antibiotic use in long-term care settings. Embracing these approaches is critical in helping nursing homes mitigate the risks of antibiotic resistance and ensure that antimicrobial agents are utilized appropriately and when necessary.

References

Adre, C., Jump, R. L. P., & Spires, S. S. (2020). Recommendations for Improving Antimicrobial Stewardship in Long-Term Care Settings Through Collaboration. Infectious disease clinics of North

Catho, G., Centemero, N. S., Waldispühl Suter, B., Vernaz, N., Portela, J., Da Silva, S., Valotti, R., Coray, V., Pagnamenta, F., Ranzani, A., Piuz, M., Elzi, L., Meyer, R., Bernasconi, E., & Huttner, B. D. (2020). How to develop and implement a computerized decision support system integrated for antimicrobial stewardship? Experiences from two Swiss hospital systems. Frontiers in Digital Health, 2. https://doi.org/10.3389/fdgth.2020.583390

Centers for Disease Control and Prevention. (2021, August 20). Core elements of antibiotic stewardship for nursing homes. CDC. https://www.cdc.gov/antibiotic-use/core-elements/nursing-homes.html

Goebel, M. C., Trautner, B. W., & Grigoryan, L. (2021). The five Ds of outpatient antibiotic stewardship for urinary tract infections. Clinical Microbiology Reviews, 34(4). https://doi.org/10.1128/cmr.00003-20

Morris, S., & Cerceo, E. (2020). Trends, epidemiology, and management of multi-drug resistant Gram-negative bacterial infections in the hospitalized setting. Antibiotics, 9(4), 196. https://doi.org/10.3390/antibiotics9040196

Schweiger, A., Kuster, S. P., Maag, J., Züllig, S., Bertschy, S., Bortolin, E., … & Marschall, J. (2020). Impact of an evidence-based intervention on urinary catheter utilization, associated process indicators, and infectious and non-infectious outcomes. Journal of Hospital Infection, 106(2), 364-371. https://doi.org/10.1016/j.jhin.2020.07.002

Seshadri, S., Felsen, C. B., Sellers, C. R., & Dumyati, G. K. (2020). “There is no one to pick up the pieces”: Sustainability of antibiotic stewardship programs in nursing homes. Infection Control & Hospital Epidemiology, 42(4), 440-447. https://doi.org/10.1017/ice.2020.1217

Wimmer B. (2023). Urinary tract infections in long-term care: Improving outcomes through evidence-based practice. Nursing, 53(10), 30–35. https://doi.org/10.1097/01.NURSE.0000977568.34589.9f