Promoting Judicious Antibiotic Use: Results of an Outpatient-Based Randomized EMR-generated intervention study

Background. The core elements provide a framework for nursing homes (NH) to establish antibiotic stewardship programs (ASP). We report on implementation and sustainability of ASP through a hospital-NH partnership. Methods. Since 2014, a hospital-based team (HBT) assisted 9 NH in Monroe County, NY in implementing ASP. Enrollment was staggered; data are currently available from 2 NH: Facility X (470 beds, full-time medical director and Infection Preventionist (IP)) and Facility Y (288 beds, part-time medical director and IP). The HBT analyzed antibiotic data to develop initial interventions focusing on reducing urinary tract infection (UTI) treatment and quinolone use. Activities included (1) regular presentation of antibiotic days of therapy (DOT), urine culture rates and treatment appropriateness; (2) coaching on interpretation and use of data to expand interventions; (3) creation of citywide guideline for diagnosis and treatment of common infections; and (4) education of nurses, providers, and families. Results. The HBT provided drug expertise and support throughout the project; however, involvement of NH staff varied. The Facility X IP assumed responsibility for the review and feedback of urine culture data and education and the medical director educated clinicians and families on treatment guidelines. Facility Y’s ASP was led by the medical director and focused mainly on education of clinicians. Facility X saw significant reductions in all metrics in 2016. Facility Y significantly reduced their quinolone use and urine culture rate; however, this did not translate into a reduction in DOT for UTI (Table 1).