(P31) A Multidisciplinary Approach to Antibiotic Stewardship in Long-Term Care

Objective/Aim: The aim of this quality improvement project was to implement and evaluate the effectiveness of the Loeb Minimum Criteria within a long-term care (LTC) unit with the goals of decreasing unnecessary testing for urinary tract infections (UTIs) and reducing inappropriate use of antimicrobial treatment.

Background: In older adults, a UTI is the most common diagnosis for which antibiotics are prescribed and up to 70% of nursing home residents will receive at least one course of antibiotic therapy annually. The prevalence of asymptomatic bacteriuria ranges from 25-50%, and many of these patients are treated with antibiotics that are not warranted. The absence of clinical education and use of evidence-based practices lead to an increase in the potential for unnecessary testing and treatment.

Quality Improvement

Methods: Within a 30-bed LTC unit in Howard County, Maryland, UTI’s are one of the most treated infections, with 13.8% of residents being tested per month. Despite this, there is no antibiotic stewardship program in place. Fifteen nurses and one nurse practitioner (NP) participated in education sessions regarding the Loeb Minimum Criteria and were given the algorithm to follow. A post-test was administered to nursing staff following the education session to assess effectiveness. Change in behavior of the nursing staff when communicating symptoms to the provider was assessed by a pre/post- implementation survey completed by the NP. Pre-test results informed ongoing educational efforts. Urinalysis, culture and sensitivity (UA C&S) orders were monitored pre-implementation and monthly to assess for the effective use of the algorithm on ordering practices.

Results: Compared to the year prior, there was an 81% decrease in UA C&S sent during the implementation phase. This change cannot be solely attributed to the use of the Loeb Minimum Criteria due to turnover of the residents, however, provider coverage remained consistent. Following the education session, 66% of nursing staff identified greater than 50% of points outlined in the Loeb Minimum Criteria. Pre-implementation survey results identified a need for ongoing nursing education. The post implementation survey will be administered at project completion. Antibiotic prescribing practices were not able to be evaluated.

Conclusions: This project shows that increased education and awareness of antibiotic stewardship programs can influence the frequency of testing LTC residents with the potential to reduce unnecessary prescribing. Internal challenges related to staffing acted as a primary barrier to participation. The use of a multimodal approach to education proved to be impactful. Implementation of QI projects within the long-term care setting must include buy in from administration and collaboration with clinical staff. NPs are knowledgeable about antibiotic stewardship practices but lack the time needed to educate staff.

Financial Disclosure: No financial disclosures