At Grane Rx, we’re committed to providing the highest-quality long term care pharmacy services. As part of that commitment, we share an ongoing series of pharmacy updates from our Chief Clinical Officer, designed to keep you in the know on clinical topics related to LTC pharmacy services and PACE pharmacy. Antibiotics are some of the most commonly prescribed medications in Skilled Nursing Facilities. It has been shown that up to 70 percent of SNF residents will receive at least one antibiotic over the course of a year; however, approximately 25 to 75 percent of these antibiotics are prescribed incorrectly or are unnecessary. Overuse of antibiotics contributes to increased antibiotic-resistant bacteria, adverse drug events, drug interactions, colonization (where a resident has bacteria present in his or her system, but it is not causing an illness), secondary infection from resistant organisms and complications such as Clostridium difficile. Despite all of the risks associated with their use, antibiotics are still a necessary piece in the care of our elderly residents, especially those who reside in a long term care setting. These residents have a higher incidence of infections due to increased risk factors such as underlying disease states, age-related physiological changes, increased exposure to bacteria secondary to the environment of an SNF, and the use of invasive devices such as catheters or feeding tubes. A common ground needs to be achieved where a long term care facility is able to stop the misuse of antibiotics while still treating their residents appropriately—this is referred to as antibiotic stewardship.
The Role of Long term Care Pharmacy in Antibiotic Stewardship
The Centers for Disease Control and Prevention has stated that antibiotic stewardship is “a set of commitments and activities designed to optimize the treatment of infections while reducing the adverse events associated with antibiotic use.” Following President Obama’s executive order for a national action plan to combat antibiotic resistance, the Centers for Medicare and Medicaid Services proposed expanded requirements in the conditions of participation beyond the ones already in place to review and monitor the use of antibiotic drugs. On Sept. 29, 2016, CMS released these new regulations—the requirements revolve around facilities having an infection prevention and control program (IPCP). This IPCP must include protocols for controlling infections and communicable diseases as well as using antibiotics and monitoring their use, incorporate education and training sessions for facility staff, and be reviewed and updated annually. The IPCP must have been created by Nov. 28, 2016, with the antibiotic stewardship program being implemented by November 28, 2017. The IPCP must also have a designated infection prevention/control officer who is a clinician with specialized training in infection prevention and control in place by Nov. 28, 2019. The consultant pharmacist is one of the people who are qualified to fill the role of an infection prevention/control officer. The American Society of Health-System Pharmacists (ASHP) believes that pharmacists have a responsibility to take prominent roles in antibiotic stewardship by 1.) promoting the optimal use of antibiotics, 2.) reducing the transmission of infections and 3.) providing education to health professionals, patients and the public. These roles are all needed in an infection prevention/control officer. [Tweet “Learn about the role of consultant pharmacists in this #longtermcarepharmacy update”]How Can Your Long term Care Pharmacy Consultant Help You Beyond the Monthly Medication Regimen Review?
- Promoting the Optimal Use of Antibiotics. Consultant pharmacists (as infection prevention/control officers and in general) have the responsibility to ensure the optimal use of antibiotics throughout the facility. One way this can be done is by encouraging interprofessional collaboration within the facility to ensure the best team is put together to maximize resident outcomes. This team would focus on optimizing resident antibiotic care by establishing restricted antibiotic-use procedures, therapeutic interchanges and treatment guidelines to aide in the appropriate selection, dosing, monitoring and de-escalation of antibiotic therapy. Additionally, consultant pharmacists can generate and analyze quantitative data on antibiotic use through working with the lab to ensure appropriate microbial susceptibility tests are reported on residents in a timely manner. Finally, long term care pharmacy consultant pharmacists can also use information technology to enhance stewardship through surveillance, utilization and outcome reporting, and use efficient and effective systems to reduce potential errors and adverse drug events.
- Reducing the Transmission of Infections. Reducing the transmission of infections is just one of the many roles a consultant pharmacist would have as a part of antibiotic stewardship. Different ways this could be accomplished would be by encouraging routine immunization of facility staff and promoting screening for transmissible diseases, promoting adherence to standard precautions, striving for zero tolerance of health care-associated infections, and collaborating as a member of the interprofessional team in the development of guidelines for risk assessment, treatment and monitoring of patients and healthcare workers, who have been in contact with a person with a transmissible disease.
- Providing Education. A consultant pharmacist has the ability to educate all stakeholders in the antibiotic stewardship process including fellow health professionals, residents, family members and the public about antibiotic stewardship and infection prevention and control. This can be completed many different ways, but some examples of this are as follows:
- Providing education sessions for health professionals on topics such as antibiotic use and resistance, decontaminating agents, aseptic technique, and sterilization methods.
- Providing education sessions for residents and their families and caregivers on adherence to prescribed directions for use, storage, and handling of medications and other infection prevention procedures.
- Participating in public health education and awareness programs aimed at controlling the spread of infectious diseases.
- Providing exposure to antibiotic stewardship and infection prevention/control practices through training for all other pharmacists and pharmacy personnel.
