Consultant pharmacists play a very important role in long term care.  We often support nursing and providers in assurance that medications are used appropriate and safely in our residents. Antibiotic stewardship in long term care is an ever expanding topic and agencies are placing a larger role on consultant pharmacists to do more.  The question I’ve come across is what should we do at our facilities and what resources are available to help us be effective team players at antibiotic stewardship in nursing homes.

Before I get to some ideas of ways I’ve participated in antibiotic stewardship, I wanted to share the CDC guidance on ASP (antibiotic stewardship program) in long term care.  The CDC document provides some ideas on what to do and how each team member in long term care can play a role in helping to maximize appropriateness of antibiotic therapy.

Like many other healthcare institutions, resources in nursing homes are limited.  I know from a consultant pharmacist perspective, adding one more project isn’t always the easiest thing to do.  If you don’t have a lot of extra time, start simple. Could you spend 5-10 minutes with the infection control nurse leader and see if he/she has any ideas of potential weaknesses where improvements could be made in antibiotic stewardship? Would you have time to review those patients on long term prophylaxis for UTI’s (something you probably should be doing already as your facility could be cited for F757)?  Those are just a couple of ideas.  Here’s a few things that I’ve participated in long term care;

1. Presentations to nursing staff surrounding use of antibiotics in pneumonia
2. Review of infections and antibiotics data collected by infectious disease nurse to help identify trends/concerns
3. Vaccination education and the important role that they can play in preventing disease and ultimately reduce our antibiotic burden
4. Development of a UTI fax form to ensure nursing staff is looking for adequate symptoms in relation to notifying a physician and requesting a UA/UC
5. Reviewing antibiotics in the emergency kit to ensure appropriateness of agents
6. Participate in quarterly meetings where antibiotic stewardship information is presented
7. UTI presentations to nursing staff
8. Identification and continuous review of patients on chronic antibiotic prophylaxis

These are just a few ideas and ways that I’ve participated in the past with regards to helping with antibiotic stewardship in long term care.  In summary, I encourage you not to be overwhelmed by antibiotic stewardship.  I think the most important thing is to do something and start somewhere!