A resident safety program is highly effective in reducing unnecessary antibiotic use in assisted living communities and nursing homes, according to a new study.
Researchers from Johns Hopkins University School of Medicine and NORC at the University of Chicago found that the Agency for Healthcare Research and Quality’s Safety Program for Improving Antibiotic Use is effective in helping long-term care providers ensure that residents receive the right dosage of antibiotic medications.
According to the study, 439 of the 523 long-term care communities that completed the full year of the AHRQ safety program saw significant decreases per 1,000 resident days for both the number of antibiotic treatment courses started and length of therapy using fluoroquinolones and other oral antibiotics.
A greater reduction in oral antibiotics compared with those given intravenously also was realized. The researchers said that oral antibiotics were a target of the program because they are used more frequently in the long-term care setting than in other settings.
Facilities also significantly reduced the number of urine cultures performed. That is important because routine urine tests may be positive for harmless or protective bacteria, leading to unnecessary antibiotic therapy, according to study lead author Morgan Katz, M.D., an assistant professor of medicine at Johns Hopkins Medicine.
“Particularly worth noting was our finding that improvements in antibiotic use were more pronounced in LTCs with greater engagement in the ASP [antibiotic stewardship program], suggesting that for antibiotic stewardship, those who do the work get the results,” she said in a news release.
Track record of success
The success of the long-term care program follows a similar program in more than 400 U.S hospitals in early 2021. In that program, hospitals reduced the emergence of drug-resistant bacteria and outbreaks of hospital-acquired infections, including Clostridioides difficile.
The long-term care safety program included webinars on the strategies for operating an antibiotic stewardship program in a long-term care facility, the importance of teamwork, and how to treat infections with the appropriate levels of antibiotics. The webinars were repeated three times over a year, from December 2018 to November 2019.
It can be challenging to implement effective stewardship programs in long-term care settings due to high staff turnover rates and limited resources, Katz noted.
“Reframing antibiotic use as a patient safety issue, and incorporating direct care staff in the prescribing process, can make these programs more sustainable,” she said.
Researchers said that more data are needed to evaluate the sustainability of the interventions and the long-term effect on antibiotic use, health outcomes, and staff and resident satisfaction.
The Northwestern Feinberg School of Medicine and VA Northeast Ohio Healthcare System also participated in the study, which was published in the journal JAMA Network Open.
