190. Survey of Antimicrobial Stewardship (AMS) Practices in Rhode Island (RI) Long-Term Care Facilities (LTCFs)
Session: Poster Abstract Session: Antimicrobial Stewardship: Current State and Future Opportunities
Thursday, October 8, 2015
Room: Poster Hall
  • IDweek_2015_Survey LTCF-FINAL.pdf (612.4 kB)
  • Background: Antimicrobial resistance is a major public health threat.  The Obama administration recently issued a national plan for combating antibiotic-resistant bacteria, which calls for AMS advancement in LTCFs nationally by 2020.  At this time, the scope of AMS practices in RI LTCFs is largely unknown.

    Methods: In November 2014, the RI  Department of Health collaborated with a task force comprised of local healthcare-associated infections stakeholders to adapt and administer an Advancing Excellence campaign survey to assess LTCF AMS. We faxed and emailed survey notices to all RI LTCFs (N=88) and requested that each facility respond via an electronic version (SurveyMonkey).  In the week prior to and following the survey deadline, we phoned Administrations of LTCFs that had not responded and requested that their staff respond. Response data were analyzed using descriptive statistics in Stata 13 and Excel6.

    Results: Representatives from 99% (87/88) of RI's LTCFs responded to the survey.  The mean size of facilities was 101 beds.  Most respondents were directors of nursing (59%).  Half (51%) reported having written policies for AMS activities.  Few (28%) reported having a formal, written statement of support for AMS.  Even fewer (15%) reported having any budgeted financial AMS support.  Few (38%) reported having a process to review antibiotic orders after 3 days to assess appropriateness.  Most (92%) reported having a monthly report of antibiotic use provided by pharmacy.  Most (75%) reported that feedback was provided to medical personnel regarding their antibiotic prescribing practices.  Most (89%) reported having a pharmacist or physician who provides expertise on antibiotic use.  Only 54% reported having a physician available for infectious diseases (ID) consult within 48 hours of a request.  Mean AMS allocations for ID physicians was 0.02 full-time equivalents (FTE), with most (83%) reporting 0. Mean AMS allocations for ID pharmacists was 0.006 FTE, with most (84%) reporting 0.

    Conclusion: AMS practices vary widely among RI LTCFs. The majority of facilities face significant barriers to AMS, such as limited financial support and lack of trained physicians and pharmacists. Interventions and resources are critically needed to overcome these barriers and advance AMS throughout RI LTCFs.

    Haley Morrill, PharmD1,2,3, Nicole Alexander-Scott, MD, MPH4, Rosa Baier, MPH5, Sara Kavoosifar, MPHs6, Leonard Mermel, DO, ScM, FACP, FIDSA, FSHEA7 and Kerry Laplante, PharmD1,2,3,7, (1)Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Providence, RI, (2)Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, (3)College of Pharmacy, University of Rhode Island, Kingston, RI, (4)Rhode Island Department of Health, Providence, RI, (5)Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, RI, (6)Brown University School of Public Health, Providence, RI, (7)Warren Alpert Medical School of Brown University, Providence, RI


    H. Morrill, None

    N. Alexander-Scott, None

    R. Baier, None

    S. Kavoosifar, None

    L. Mermel, CareFusion: Consultant , Consulting fee and Research grant
    Marvao Medical: Consultant , Consulting fee and Research grant
    Bard: Consultant , Consulting fee
    Fresenius: Consultant , Consulting fee
    3M: Consultant , Consulting fee

    K. Laplante, Cubist Pharmaceuticals: Grant Investigator , Scientific Advisor and Speaker's Bureau , Consulting fee , Grant recipient and Speaker honorarium
    Pfizer Pharmaceuticals: Grant Investigator , Grant recipient
    Theravance Biopharma: Grant Investigator and Scientific Advisor , Consulting fee and Grant recipient
    Durata: Scientific Advisor , Consulting fee
    Forest Laboratories: Scientific Advisor , Consulting fee
    Marvao: Grant Investigator , Grant recipient
    Melinta: Scientific Advisor , Consulting fee
    Davol: Scientific Advisor , Consulting fee
    Theradoc: Scientific Advisor , Consulting fee

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.