Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare
A new study published today [February 28, 2022] in JAMA Network Open shows that long-term care facilities that participated in a safety program funded by the Department of Health and Human Services (HHS) through the Agency for Healthcare Research and Quality (AHRQ) saw a significant decrease in antibiotic use, thereby reducing unnecessary and potentially unsafe use of medications.
The study evaluated the implementation of the AHRQ Safety Program for Improving Antibiotic Use in 439 long-term care facilities across the United States, and found that participating facilities reduced their antibiotic starts—that is, the number of new courses of antibiotic treatments—and reduced the number of days residents were on antibiotics. Participating facilities also significantly reduced use of fluoroquinolones, a class of antibiotics known to cause adverse effects in older adults. Facilities that were highly engaged in the AHRQ program saw greater reductions in antibiotic use than facilities with low engagement.
“There are practical, evidence-based steps long-term care facilities can take to improve antibiotic use and reduce the risk of resistance,” said AHRQ Deputy Director David Meyers, M.D. “This is a great example of what AHRQ does: create programs that make it simple to put evidence into practice—thus promoting patient safety and improving patients’ lives.”
Antibiotic prescriptions are common in long-term care facilities, yet up to 75 percent of them are considered inappropriate or not following guidelines. Antibiotic stewardship programs (ASPs) are designed to address this by promoting the appropriate use of antibiotic medications to improve patient outcomes, reduce antibiotic resistance, and decrease the spread of infections caused by antibiotic-resistant organisms.
Inappropriate use of antibiotic medications is a significant public health challenge because overuse can enable organisms to develop a resistance to antibiotics, rendering them ineffective. As part of efforts to reduce threats posed by antibiotic-resistant organisms, the Centers for Medicare & Medicaid Services requires that long-term care facilities establish ASPs.
Facilities participating in AHRQ’s safety program between December 2018 and November 2019 attended webinars and used an array of content and practical tools to:
- Reduce overall antibiotic use, with a mean reduction in their antibiotic starts by 0.41 per 1,000 resident days.
- Significantly reduce oral antibiotic use compared with intravenous antibiotics, which is important because oral antibiotics are used more frequently.
- Significantly reduce orders for urine cultures, which are often ordered without clear indications and provide results that do not reliably indicate an infection is present in the elderly.
“These results suggest that long-term care facilities can successfully reduce inappropriate antibiotic use. And there are free tools and resources developed as part of this program that can help facilities achieve these goals,” said Melissa A. Miller, M.D., M.S., who is a co-author of the study and a medical officer in AHRQ’s Healthcare-Associated Infections (HAI) division.
Based on the findings from the facilities that participated in this safety program, AHRQ released the Toolkit to Improve Antibiotic Use in Long-Term Care in June 2021. The toolkit includes resources, webinars, and practical tools that frontline staff can use to incorporate antibiotic stewardship principles into routine decision making through a novel framework called the Four Moments of Antibiotic Decision Making.
The program was developed and implemented by a multi-disciplinary team of clinicians and experts from Johns Hopkins University School of Medicine, NORC at the University of Chicago, Northwestern University Feinberg School of Medicine, and the VA Northeast Ohio Healthcare System. More information about AHRQ’s HAI Program, which funds work to help frontline clinicians and other healthcare staff prevent HAIs by improving how care is delivered to patients, can be found at www.ahrq.gov/hai/index.html.
This February 28, 2022 AHRQ Press Release can be found here.