Author – David P. Calfee, MD, MS
Associate Professor of Medicine and Public Health at Weill Cornell Medical College,
Chief Hospital Epidemiologist at New York-Presbyterian Hospital/Weill Cornell in New York City
The GNYHA, UHF, and NYSDOH Antimicrobial Stewardship Project
While most discussions of antibiotic resistance and improving antibiotic prescribing practices (“antimicrobial stewardship”) focus on hospitals, antibiotic resistance and inappropriate antibiotic use are also prevalent in long-term care facilities (LTCFs). In fact, antibiotic resistance rates in LTCFs are often higher than in hospitals. Consequently, in 2009 the Greater New York Hospital Association, United Hospital Fund, and New York State Department of Health launched the Antimicrobial Stewardship Project.
The project pursued effective strategies for antimicrobial stewardship programs in LTCFs to demonstrate that beneficial activities could be performed without significant investment in new resources, and to demonstrate the value of hospital-LTCF partnerships in antimicrobial stewardship activities. Another goal was to develop tools and materials to assist project participants and other healthcare facilities to develop and manage their antimicrobial stewardship programs.
The project included three LTCFs partnering with three hospitals. The collaboration was intended to provide access to infectious disease physicians and pharmacists, important roles in antibiotic stewardship activities but rarely available to LTCFs. The sponsors provided a kickoff meeting, monthly conference calls, site visits, access to experts in antimicrobial stewardship, tools to assist with program activities, and a culminating meeting where participants shared implementation experiences. Participating facilities assessed current prescribing practices, built teams, identified 1-2 target areas for intervention, set goals, and implemented goal-reaching strategies. In less than a year, participants showed that it is possible to improve antibiotic prescribing practices in LTCFs. Success was attributed to motivated teams, support from administrative and clinical leadership, and focused efforts to improve teamwork and communication.
Other factors that appeared to be useful were access to ready-made tools to assist stewardship activities and a forum to discuss challenges and best practices. We are now surveying participating facilities to determine if their quality improvement activities have been sustainable and if they have expanded their programs. While antimicrobial stewardship is complex and lacks a “one size fits all” approach, this project showed that it can be done. We hope to see similar programs introduced in other LTCFs.