Consultant Pharmacists Can Help Improve Antibiotic Use in Nursing HomesPosted on by
Guest Author: Nicole Brandt, PharmD, MBA, BCPP, CGP, FASCP
Professor, Geriatric Pharmacotherapy, Pharmacy Practice and Science UMB School of Pharmacy
Director, Clinical and Educational Programs of Peter Lamy Center Drug Therapy and Aging
As a consultant pharmacist, I work with nursing homes and their inter-professional teams to meet the medication needs of all residents. I complete medication regimen reviews (MRRs), which include reviewing medical charts for information on recent labs and vital signs; interviewing staff, residents and/or family; and examining all medications – prescription, over-the-counter, and vitamin/herbal supplements. MRRs must be completed for each resident at least once a month and are mandated under federal regulations for nursing home care (i.e., F-428). The regulations also require the pharmacist to report any “irregularities” to the resident’s physician and the director of nursing. These irregularities must be acknowledged and acted upon.
I also actively participate in the quality assurance program initiatives (QAPI), which address issues such as reducing adverse events and improving use of medications (e.g., antipsychotics, antibiotics). For instance, the inappropriate use of antibiotics can result in drug-resistant infections and Clostridium difficile (C. difficile). In frail older residents, severe diarrhea, fever, and weight loss from C. difficile can be life threatening. I review information from the lab on the organisms identified in the culture with the antibiotics used to treat a resident, and sometimes, discover residents are taking medications to which bacteria are resistant.
While C. difficile is thankfully uncommon in my nursing homes, urinary tract infections (UTIs) are not. As a consultant pharmacist, it’s my job to assist with a root cause analysis by asking key questions such as:
- Do certain residents seem prone to UTIs?
- Are there preventative strategies in place?
- Are residents taking medications that cause urinary retention, such as medications for overactive bladder?
I examine how the diagnosis of UTI was made. Older adults often test positive for bacteria in a urine culture without UTI symptoms. I ensure there is documentation demonstrating antibiotic need, and that the medication, dose, and duration are appropriate. Programs focused on improving UTI management help to reduce unnecessary antibiotic use, which in turn reduces bacterial resistance and C. difficile infections.
At the end of a busy day, I leave the facility feeling satisfied that the suggestions I’ve made as a consultant pharmacist may result in safer medication use for the patients I serve and help the facility meet and exceed their quality improvement goals. I have a great job!