1829. A Systems Approach to Nursing Home Antimicrobial Stewardship
Session: Poster Abstract Session: Antimicrobial Stewardship: Non-hospital Settings
Saturday, October 6, 2018
Room: S Poster Hall

Up to 70% of nursing home (NH) residents receive one or more courses of antibiotics (ATB) annually, of which over half may be inappropriate and risk harm. The current availability of in-house NH data is often insufficient to measure and track appropriateness, due to incomplete data or unusable formatting. Our three-year project to improve antimicrobial stewardship (AMS) used the Centers for Disease Control and Prevention’s (CDC) Core Elements of AMS for NHs, with guided input from NH providers to develop and implement an electronic ATB de-escalation decision support tool that also captures otherwise inaccessible data.


Our baseline assessment identified wide variation in providers’ knowledge, attitudes, and beliefs regarding ATB prescribing, leading us to identify de-escalation as the most feasible NH AMS intervention. Using facilitated open-ended conversations with leaders from three NH corporations, we developed an electronic decision support tool to systematically prompt de-escalation 48-72 hours post-prescribing. Subsequent site visits with NH clinical teams at a convenience sample of sites allowed us to explore how to incorporate decision support into their electronic health record (EHR).


We developed a tool anchored on data capture for the “acute change in condition” that triggers prescriber interactions. It uses clinical and laboratory data to prompt structured communication between nurses and prescribers. Placing this tool in the EHR reduced duplicate charting, enabled guidance from McGeer and Loeb criteria, and promoted its adoption into practice while ensuring data capture to assess appropriateness of ATB prescribing.


Our electronic decision support tool captures clinical and laboratory data, which it then uses to systematically prompt conversations about de-escalation between nurses and prescribers, reducing variation in practice. Upon completion, the assessment ensures availability of data to assess, track, and report appropriate prescribing practices among prescribers. This tool proved acceptable to NH providers in three different corporations, suggesting feasibility of further expansion of this approach to a broader group of NH providers.

Stefan Gravenstein, MD, MPH1,2,3, David Manning, ScM4, Rosa R. Baier, MPH4, Christopher Crnich, MD, PhD5, H. Edward Davidson, PharmD, MPH6, Kerry LaPlante, Pharm.D., FCCP, FIDSA7, David Dosa, MD, MPH2,8 and Robin Jump, M.D., Ph.D.9, (1)Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, (2)Long Term Services and Supports-COIN, Providence VA Medical Center, Providence, RI, (3)Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, Providence, RI, (4)Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, RI, (5)University of Wisconsin School of Medicine and Public Health, Madison, WI, (6)Insight Therapeutics, LLC, Norfolk, VA, (7)College of Pharmacy, University of Rhode Island, Kingston, RI, (8)Health Service, Policy & Practice, Brown University School of Public Health, Providence, RI, (9)Case Western Reserve University School of Medicine, Cleveland, OH


S. Gravenstein, None

D. Manning, None

R. R. Baier, None

C. Crnich, None

H. E. Davidson, Sanofi Pasteur: Collaborator , Research support . Seqirus: Collaborator , Research support .

K. LaPlante, None

D. Dosa, None

R. Jump, None

Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.