Methods: A semi-structured phone survey was administered to 69 key informants in Wisconsin NHs that had previously completed a web-based structured survey. Questions focused on: 1) the individuals involved in the ASP and their tasks; 2) methods for tracking and reporting antibiotic utilization; 3) existing policies and procedures; 4) methods to improve antibiotic use; and 5) barriers and facilitators of ASP activities.
Results: 24 of 69 (35%) eligible WI NHs participated in the survey. The majority (83%) of NHs reported having an ASP. Individuals engaged in ASPs were director of nursing (DON; 75%), medical director (75%) and infection preventionist (IP; 71%). Consultant (46%) and on-site pharmacist (13%) involvement was less common and no facility reported involvement of an individual with ID expertise. 83% of NHs tracked antibiotic although most did not standardize or trend their data (46%). Most NHs (92%) engaged in education on appropriate antibiotic use targeting nursing staff (83%), providers (46%) and families (17%). 88% of NHs reported assessing appropriateness of antibiotics starts. Provider feedback was mostly performed by the IP or nursing staff although the medical director played a key role in this process (47%, n=19); the pharmacist played a lesser role. Tools to improve antibiotic use included: antibiograms (37%), interventions to improve nurse-provider communication (29%), antibiotic timeouts (12%), or provider report cards (8%). No facility reported use of formulary restriction, prior authorization, or decision-support integration.
Conclusion: Our study demonstrates structure and process of APSs in WI NHs differ from hospitals. Nursing staff are highly engaged in NH ASP, but medical director and pharmacist ASP involvement is sub-optimal. WI NHs employ basic stewardship strategies but rarely use more advanced methods. Identifying more efficient and effective strategies to improve existing methods and implement more advanced methods is critically needed.
D. Nace, None
C. Crnich, None