Many of us have or will have loved ones in long term care facilities. These healthcare settings are critical to providing healthcare and everyday assistance to people with chronic illnesses or disabilities, who otherwise would be unable to take care of themselves. Like other healthcare settings, antibiotics are not always used correctly or wisely in long term care. We are glad that CDC is addressing and promoting the appropriate use of antibiotics to ensure the prolonged use of these important drugs and delay the rise of untreatable infections.
We believe that medical directors of long term care facilities can have enormous impact on appropriate antibiotic use. Here are some things they can do to ensure correct use of antibiotics for your loved ones:
- It is important that long term facilities have clear policies and practices to ensure that patients are not started on antibiotics when it is not necessary.
- Medical directors of facilities should assist in establishing minimum criteria for defining infections and initiating antibiotics. Consensus guidelines for LTC (e.g., McGeer, Loeb) could be used as a starting point.
- Medical directors must also be aware of increases in antibiotic resistant bacteria in their facilities to be certain that antibiotics prescribed will work for treating infections.
- In some facilities, a more intense audit of antibiotic use may be warranted to improve the appropriateness of antibiotic prescribing. This antibiotic review can be performed by the infection prevention nurse or the director of nursing service and then shared with the medial director. When a high rate of inappropriate antibiotic use is identified, medical directors should develop a plan for improvement. Plans to optimize antibiotic prescribing may include practitioner education, introduction of an antibiotic formulary, development of antibiotic prescribing guidelines, and feedback of monitored data to individual practitioners.
The medical director has a key role in helping a long term facility incorporate good antibiotic stewardship into resident care policies and procedures/guidelines. Let us know about facilities who are leading the way in this important effort.