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Core Elements of AMS for Nursing Homes

The Centers for Disease Control and Prevention have identified a set of core elements necessary for the successful implementation of an antibiotic stewardship program in nursing homes. See the CDC's complete reference, download a printer-friendly version of Qualis Health's checklist, and use the suggestions for further assistance.

	Nursing Home Antibiotic Stewardship Checklist Adapted by the NHQCC team from the CDC original		Corresponding Suggestions from Qualis Health's NHQCC team
	Leadership Support
	Our facility leadership: ✔ Documented their commitment to improve antibiotic use ✔ Monitors compliance with antibiotic stewardship policies ✔ Reviews antibiotic use and resistance data in quality assurance meetings Antibiotic stewardship duties are included in the position description of our: ✔ Medical director ✔ Director of nursing		Qualis Health Public commitment to the wise use of antibiotics See resources related to tracking and reporting data in the sections below. Other ways to demonstrate leadership commitment: Antibiotic stewardship accountability documents Budget plans that allot FTEs to infection control and antibiotic stewardship Infection prevention plans that reference antibiotic stewardship Performance improvement plans that target antibiotic stewardship Strategic plans that reference antibiotic stewardship Using the electronic health record to collect antimicrobial stewardship data
	Accountability
	✔ The following staff have been assigned as leads for antibiotic stewardship activities:		Consider creating an antibiotic stewardship accountability grid (see sample) to ensure clarity and complete coverage of the antibiotic activities.
	Drug Expertise
	✔ The following antibiotic stewardship experts contribute to facility activities:		Consider asking your consulting pharmacist or stewardship consultant if s/he has earned certificates or educational units related to antibiotic or antimicrobial stewardship, such as those offered from: MAD-ID Antimicrobial Stewardship Training Program Society of Infectious Diseases Pharmacists Pharmacists Certificate Program Consider asking your pharmacist or stewardship consultant to complete a self-assessment of antibiotic stewardship knowledge, such as these guidelines from the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America.
	Actions to Improve Antibiotic Use
	Our facility: ✔ Requires prescribers to document a dose, duration, and indication for all antibiotics ✔ Monitors compliance with stewardship policies ✔ Reviews antibiotic agents listed on the medication formulary ✔ Utilizes a standard assessment and communication tool for residents suspected of having an infection ✔ Shares antibiotic use information with, or gathers information from, the other healthcare facility when a resident is transferred ✔ Conducts an antibiotic review process / “antibiotic time out” ✔ Implemented an infection-specific intervention to improve antibiotic use for these conditions: ✔ Developed reports summarizing the antibiotic susceptibility patterns (e.g., facility antibiogram) ✔ Other: We have developed facility-specific: ✔ Algorithms for assessing suspected infections ✔ Algorithms for appropriate diagnostic testing (e.g., obtaining cultures) for specific infections ✔ Treatment recommendations for infections ✔ Other: Our consultant pharmacist: ✔ Reviews antibiotic courses for appropriateness of administration and/or indication ✔ Establishes standards for clinical/laboratory monitoring for adverse drug events from antibiotic use ✔ Reviews microbiology culture data to assess and guide antibiotic selection ✔ Other:		Qualis Health Sample policy for "Antibiotics Time-out" and sample SBAR format of a time-out request to send to the prescriber AHRQ Sample Antibiotic Stewardship Policy & Procedure AHRQ Sample Policy: Minimum Criteria for Infections AHRQ Sample Letter to Prescriber CDC Clinician Guide to Collecting Cultures AHRQ Suspected Urinary Tract Infection SBAR AHRQ Suspected Lower Respiratory Tract Infection SBAR AHRQ Suspected Skin and Soft Tissue Infection SBAR AHRQ A Medical Care Referral Form to document information for prescribing clinicians AHRQ Minimum Criteria for Antibiotics Tool AHRQ Pocket Card for each of the following: MRSA C. Difficile VRE Situations when antibiotics are not indicated AHRQ Resources for antibiogram: Created by lab Created in nursing home AHRQ Resources for Antibiogram Reporting Policies and Implementation
	Tracking
	*Our facility monitors the following measures* of antibiotic use: ✔ Adherence to clinical assessment documentation (signs/symptoms, vital signs, physical exam findings) ✔ Adherence to prescribing documentation (dose, duration, indication) ✔ Adherence to facility-specific treatment recommendations ✔ Point prevalence surveys of antibiotic use ✔ New antibiotic starts/1,000 resident-days ✔ Antibiotic days of therapy/1,000 resident-days ✔ Other: Our facility monitors the following outcomes of antibiotic use:** ✔ Rates of C. difficile infection ✔ Rates of antibiotic-resistant organisms ✔ Rates of adverse drug events due to antibiotics ✔ Other:		AHRQ Sample Antibiotic Use Tracking Sheet AHRQ Sample Monthly Antibiotic Summary Report National Nursing Home Quality Improvement Campaign C. Diff Tracking Tool West Virginia Department of Health and Human Resources Sample MDRO Infection Tracking Tool Signs and symptoms of possible adverse drug event related to antibiotics (especially in residents with history of renal disease, concurrent course of medications that raise PT/INR or PTT, concurrent course of phenytoin, or concurrent course of other antibiotics): Elevated kidney function tests Elevated liver function tests Elevated serum potassium Decrease in platelets Nausea/vomiting Diarrhea Loss of appetite Flushing of skin Lethargy Dizziness Hearing loss Rash Seizures Ventricular arrhythmias Peripheral neuropathy
	Reporting
	✔ We give providers written feedback regarding their antibiotic prescribing We provide staff with reports that include the following facility-specific measures: ✔ Antibiotic use ✔ Outcomes related to antibiotic use (i.e., C. difficile rates) ✔ Antibiotic susceptibility patterns (within last 18 months)		AHRQ Sample Individualized Antibiotic Prescribing Profile Report
	Education
	Our facility provides educational resources about antibiotic resistance and improved use to: ✔ Clinical providers (e.g., MDs, NPs, PAs, PharmDs) ✔ Nursing staff (e.g., RNs, LPNs, CNAs) ✔ Residents and families ✔ Other:		AHRQ Training slides: Medical Care Referral Form AHRQ Training slides: Minimum Criteria for Common Infections CMS' QIO Program Nursing Home Training Sessions AHRQ Antibiotic Stewardship Educational Resources for Residents and Families EQuIP for LTC Training Materials and Webinars CDC Antibiotic Fact Sheets

Download a printer-friendly version of this checklist.

Return to resource listing for our NHQCC Learning Session #2.