(P51) The Tailored Adoption of a National Clinical Antimicrobial Stewardship Program

Objective/Aim: To rapidly adopt a tailored antimicrobial stewardship program (ASP) using evidence-based tools and workflow processes to reduce unnecessary antibiotic prescriptions by 5% in a comprehensive skilled nursing facility (SNF) by the end of August 2022.

Background: Yearly, 75 percent of the antibiotics prescribed to 4.1 million Americans who are admitted to or reside in an SNF are inappropriate. Harms caused by antibiotic overuse are significant for the frail and elderly receiving care in an SNF. Antibiotic stewardship is a national priority for the Center for Disease Control and Prevention (CDC), and Agency for Healthcare Research and Quality (AHRQ) released a set of leadership commitments and actions designed to optimize the treatment of infections while reducing the adverse events associated with antibiotic use advancing a culture of safety, learning, and disseminating best evidence-based practices (1,2)

Quality Improvement

Methods: Ascension Living introduced an ASP playbook at Ascension Living Providence Village, a 165-bed SNF in Waco, Texas. Baseline data was measured by overall systemic antibiotic prescriptions per 1000 resident days, the average duration of antibiotic therapy, new systemic antibiotic prescriptions per month, fluoroquinolone prescriptions per month, and urine cultures ordered per month. We integrated a plan, do, check, act (PDCA) cycle process to assess stakeholder impact, defined roles and workstream using the CDC and AHRQ core tenets of antibiotic stewardship with new urinary infection and respiratory infection guidelines and pathways. We also started a monthly data dashboard report and a bi-monthly meeting with the facility leadership team (Chief Medical Officer, Director of Infection Prevention, Director of Quality, Medical Director, and Pharmacy). We defined educational gaps and quality assurance improvements to engage associates while reinforcing leader accountability, recalibrating tactics, and sharing data and wins.

Results: The baseline period for comparison was January-March 2022, while the intervention period was April-August 2022. The results were as follows: overall systemic antibiotic orders per 1000 resident days decreased by 25% (from 18.2 to 13.6 orders per 1000 residents days), the average duration of systemic antibiotic therapy decreased by 12% (from 7.6 to 6.7 days), new orders for systemic antibiotics decreased by 24% (from 94 to 71 orders per month), fluoroquinolone antibiotic prescriptions decreased by 51% (from 18 to 9 orders per month), and urine culture orders decreased by 24% (from 22.7 to 17.2 cultures/month).

Conclusions: Our findings suggest that the adoption of a tailored ASP with enhanced evidence-based tools rapidly sustained a reduction in the overall core metrics of antimicrobial stewardship in the long-term care setting.