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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



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:

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)



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




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




Qualis Health
Sample policy for "Antibiotics Time-out" and sample SBAR format of a time-out request to send to the prescriber

Sample Antibiotic Stewardship Policy & Procedure

Sample Policy: Minimum Criteria for Infections

Sample Letter to Prescriber

Clinician Guide to Collecting Cultures

Suspected Urinary Tract Infection SBAR

Suspected Lower Respiratory Tract Infection SBAR

Suspected Skin and Soft Tissue Infection SBAR

A Medical Care Referral Form to document information for prescribing clinicians

Minimum Criteria for Antibiotics Too

Pocket Card
for each of the following:

  • MRSA
  • C. Difficile
  • VRE
  • Situations when antibiotics are not indicated

Resources for antibiogram:

Resources for Antibiogram Reporting Policies and Implementation




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




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




Sample Antibiotic Use Tracking Sheet

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



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)


Sample Individualized Antibiotic Prescribing Profile Report




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





Training slides: Medical Care Referral Form

Training slides: Minimum Criteria for Common Infections

CMS' QIO Program
Nursing Home Training Sessions

Antibiotic Stewardship Educational Resources for Residents and Families

Training Materials and Webinars

Antibiotic Fact Sheets



Download a printer-friendly version of this checklist.

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