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Prepare Your Facility for the Antibiotic Stewardship Program – Part 2

In Part 1 of this blog, you learned what the Antibiotic Stewardship program was and a few steps to get started on implementing a unique ASP in your facility.

Once you have those prepared, you can start looking at what the right workflow will be for your team, possibly utilize an antibiogram for your facility to make the best decisions on how to apply antibiotics, and take a look at some toolkits to help you create a successful program.

What Will the ASP Workflow Look Like?

Once the infection preventionist (IP) is selected, that person is responsible for collecting data on infections occurring within the facility.

The IP then takes the facility’s antibiogram data and gets information from the lab about how past bacterial infections have been treated in the facility (antibiograms are explained below). The IP will also get antibiogram information from referring hospitals, depending on how many referrals they’ve made to that nursing facility, and put together an idea about what infections are seen most often and which antibiotics are going to have the most chance of success in the facility.

It’s important that every diagnosis be confirmed by lab work. Once the diagnosis is made, the doctor orders antibiotics per the protocols put in place under the ASP and the nurse checks that it is correct. If it is not correct, the nurse will request that the correct medication be ordered.

What’s an Antibiogram and Where Does It Come Into Play?

An antibiogram is a data set that comprises commonly seen bacteria and the different antibiotics they respond to. It will also show resistance trends over time. Each antibiogram is specific to its facility.

Every hospital has an antibiogram, some with specific antibiograms for individual units, such as the ICU. Long-term care facilities may also have antibiograms if there have been enough infections for personnel to gather the required data.

The antibiogram is the engine of the stewardship program. It’s what you use to make your choices of antibiotics as part of your ASP. Center staff should request an antibiogram from the facility’s lab partner and may want to request one from each referring hospital, as well.

“You look at all of them and come up with a plan around how you’re going to apply antibiotics to infections in this facility,” says Worz. “All those different referring hospitals and their bacteria are entering your facility via the residents that you admit every day, so it’s changing the population of bacteria in your facility. That’s what you really have to get knowledge—treatment-of-choice protocols to not further drive resistance, more effectively treat the residents, and not give them an antibiotic that could potentially lead to treatment failure.”

Where Can I Learn More?

That might feel like an information overload. But try not to feel overwhelmed. Several toolkits have been developed to walk you through step by step as you implement the ASP in your facility. The first two are free, and the last can be purchased through ASCP.

CDC: The Core Elements of Antibiotic Stewardship For Nursing Homes

AHRQ: Nursing Home Antimicrobial Stewardship Guide (4-part toolkit)

Reviewed and revised 3/1/21


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