983. Antimicrobial Stewardship Program Development in a Long-Term Care Facility
Session: Poster Abstract Session: Stewardship: Implementing Programs
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C

Antibiotic use in long-term care facilities (LTCF) is high and often inappropriate. Antimicrobial stewardship programs (ASP) improve patient safety, reduce healthcare costs and may impact rates of antibiotic resistance; however ASP guidance focuses on hospitals. Antibiotic treatment of asymptomatic bacteriuria is common in LTCF. We began a pilot program with a LTCF to assess baseline knowledge and practice to implement an ASP.


Staff prescribers (physicians and nurse practitioners) and nurse managers in a 340 bed LTCF were surveyed to assess knowledge and beliefs about antibiotic use and urinary tract infection (UTI) management.  Survey questions were Likert-scaled 1 to 5, with 5 indicating strong agreement. Available data sources were: Pharmacy Antibiotic Report, Infection Log and Daily Nursing Report. Prescribing data from December 2012 – February 2013 were reviewed.


All (4/4) staff prescribers and 79% (20/24) nurse managers completed surveys. All prescribers and 50% of nurse managers believed antibiotic use leads to family perception of high-quality care. Notably, 50% of prescribers and 50% of nurse managers believed that antibiotics were almost always appropriate for residents with new confusion and history of UTI with indwelling catheter, and 50% prescribers and 39% nurse managers without an indwelling catheter.  From December 2012 – February 2013, 79 antibiotic courses were dispensed: 26 (33%) had no stated indication and 12 (15%) were for UTI. Of the 12 prescriptions for UTI, 7 (58%) had no documentation of UTI on the Infection Log or Daily Nursing Report.


Antibiotic use in this LTCF was high (1 of every 4-5 residents); documentation of clinical indication for antibiotic was often missing or inconsistent between data sources. Surveying prescribers and nurse managers uncovered a bias towards prescribing antibiotics and a lack of understanding of UTI management.  A pre-program assessment provided the framework for an ASP by identifying available data sources, highlighting documentation incompleteness, establishing an antibiotic utilization baseline, and identifying educational needs for bacteriuria management.

Jane Harper, BSN, MS, CIC1, Lindsey Lesher, MPH2, Aaron DeVries, MD, MPH2, Linn Warnke, RN, MPH1 and Ruth Lynfield, MD1, (1)Acute Disease Investigation and Control, Minnesota Department of Health, St. Paul, MN, (2)Minnesota Department of Health, St. Paul, MN


J. Harper, None

L. Lesher, None

A. DeVries, None

L. Warnke, None

R. Lynfield, None

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