Promoting Antimicrobial Stewardship

Guest post by Barbara J. Zarowitz, PharmD, BCPS, BCGP, FCCP, FASCP

We have all seen the headlines warning of “bad bugs” with no cure for an infection as a result of the overuse and misuse of antibiotics in a variety of healthcare settings. In hospitals, strategies to promote appropriate use of antibiotics and thus reduce antibiotic resistance, improve patient outcomes, and cut costs, have been a focus of quality improvement for years. In the last 2-3 years, the impetus to improve antibiotic use in long-term care facilities has stimulated a wide variety of campaigns, and development of clinical tools and tactics for this population of vulnerable older adults.

Governmental agencies in Canada and the United States have led many antimicrobial stewardship initiatives. In the United States, the Centers for Disease Control and Prevention (CDC) published Guidance for improvement of antibiotic stewardship in nursing homes that embraced 7 core elements (leadership, accountability, drug expertise, education, action, tracking and reporting). In cooperation with the CDC at the request of the division of healthcare quality at the State of Maryland’s (SOM) health department, the Peter Lamy Center on Drug Therapy and Aging at the University of Maryland, School of Pharmacy, hosted a Summit on Antimicrobial Stewardship in Long-Term Care Facilities. Educators and representatives from the CDC and SOM health department presented clinical and scientific content important to the initiative. Shared antibiograms, antibiotic choice, sites of infection, antibiotic side effects, outcomes and documentation of antibiotic adverse drug events (ADEs) provided participants with a wealth of knowledge, clinical tools and quality improvement skills. Attendees participated in a workshop to identify root causes of antibiotic-related misuse, outline mitigating factors, and develop an action and communication plan to correct root causes.

From the beginning, Think Research has participated in the grant to improve antimicrobial stewardship in U.S. nursing homes through their expertise in developing a prototype tool for identification and documentation of ADEs. Under the leadership of Dr. Barbara Zarowitz (Senior Advisor and Affiliate Professor, Peter Lamy Center on Drug Therapy and Aging) a series of algorithms to identify possible ADEs were developed and then with Think Research, a prototype documentation tool was designed to be embedded into electronic health records for ease of use and ready access to clinically necessary information. A highlight of the Summit in Maryland was the presentation of the Antibiotic ADE prototype and solicitation of feedback and discussion among attendees. Dr. Sarah Kabbani, Office of Antibiotic Stewardship at the CDC said, “antibiotic ADEs are perhaps one of the most important metrics we can track for improving antibiotic use because they relate directly to resident safety. We are all working together to improve the quality of care for older adults.”

In the next phase of ADE tool development, Think Research will be validating the ADE prototype and seeking partnerships with selected U.S. nursing homes to test the reliability and utility of the embedded tool.

Antibiotics are responsible for nearly half of ADEs in older adults and many are predictable and can be avoided or mitigated with lower antibiotic doses, selection of alternative agents and judicious monitoring. Improvement in antimicrobial stewardship works through interprofessional collaboration when the right partners are at the table. We owe older adults, particularly those in nursing homes, the best of our wisdom and focus of our efforts to improve the safe and effective use of antimicrobials.

Specializing in Geriatric Pharmacotherapy and Clinical Research, Barbara J. Zarowitz, Pharm. D, is the Senior Advisor at The Peter Lamy Center on Drug Therapy and Aging at the University of Maryland’s College of Pharmacy, and an Independent Consultant in Las Vegas, Nevada.