Toolkit 3. The Nursing Home Antibiogram Program Toolkit: How To Develop and Implement an Antibiogram Program

Toolkit Effectiveness

This toolkit reflects the results of preliminary work with three nursing homes to develop the antibiogram, train staff, and implement the program.¹

Overview of the Toolkit

What Is an Antibiogram and Why Should a Nursing Home Use It?

A nursing home-specific antibiogram may be an effective and inexpensive tool for improving appropriate antibiotic prescribing. An antibiogram is a report that displays the organisms present in clinical specimens that nursing homes send for laboratory testing—aggregated across all residents for a certain time period—along with the susceptibility of each organism to various antibiotics. Referring to an antibiogram report enables prescribing clinicians to make prompt, empirically based decisions. Because antibiograms provide information on local susceptibility patterns, they may help to reduce prescribing of antibiotics with high resistance rates in nursing homes and emergency departments.

What Is the Comprehensive Antibiogram Toolkit?

The Comprehensive Antibiogram toolkit aims to guide nursing homes in incorporating an antibiogram program into their standard care practices. This toolkit contains the steps and materials needed to develop and implement an effective nursing home antibiogram program. This program consists of four major phases:

• Phase 1. Assessment and Planning (PDF) (Word)
  • Assessment Tools
    • The Antibiogram Program: Nursing Home Readiness and Resources Assessment (PDF) (Word)
    • The Antibiogram Program: Clinical Prescriber Survey (PDF) (Word)
    • The Antibiogram Program: Checklist for Discussion with Local Hospitals and Providers including Emergency Departments (PDF) (Word)
  • Planning Tools
    • The Antibiogram Program: Fact Sheet (PDF) (Word)
    • The Antibiogram Program: Sample Timeline (Word)
       
• Phase 2. Development (PDF) (Word)
  • Nursing Home/Clinical Laboratory Communication
    • The Antibiogram Program: Sample Letter of Agreement (Word)
    • The Antibiogram Program: Sample Data Request (Word)
    • The Antibiogram Program: Antibiogram Specifications (PDF) (Word)
  • Antibiogram Development
    • The Antibiogram Program: Antibiogram Development Tool Workbook (Excel)
    • The Antibiogram Program: Sample Laboratory Data Print Out (PDF) (Word)
    • The Antibiogram Program: Checklist for Identifying Nursing Home-Specific Antibiogram Modifications (PDF) (Word)
    • The Antibiogram Program: Sample Antibiogram (PDF) (Word)
       
• Phase 3. Implementation (PDF) (Word)
  • Policy and Procedures
    • The Antibiogram Program: Sample Policy Document (PDF) (Word)
    • The Antibiogram Program: Sample Procedures Document (PDF) (Word)
  • Training Materials
    • The Antibiogram Program: Antibiogram Fact Sheet (PDF) (Word)
    • The Antibiogram Program: Training Slides for Clinical Prescribers (Word) (PowerPoint)
    • The Antibiogram Program: Training Slides for Nurses (Word) (PowerPoint)
    • The Antibiogram Program: Sample Vignettes and Discussion Questions (PDF) (Word)
  • Dissemination Materials
    • The Antibiogram Program: Sample Pocket Card Short Version (Word)
    • The Antibiogram Program: Sample Pocket Card Long Version (Word)
    • The Antibiogram Program: Sample Email for Distribution of the Antibiogram (PDF) (Word)
       
• Phase 4. Monitoring (PDF) (Word)
  • Quality Assurance
    • The Antibiogram Program: Antibiotic Use Tracking Sheet (Word)
    • The Antibiogram Program: Quality Improvement Review Tool for Antibiotic Use in Urinary Tract Infection (PDF) (Word)
  • Monitoring
    • The Antibiogram Program: Antibiogram Feedback Survey (Word)

Each phase contains a description of the task, instructional materials, and tools and samples that can be modified to be nursing home-specific.

How Do I Implement the Comprehensive Antibiogram Toolkit?

Implementing the Comprehensive Antibiogram toolkit involves four phases with activities within each phase. Each phase contains multiple tools to support implementation.

1. Phase 1. Assessment and Planning. This phase involves determining whether prescribing clinicians and the nursing home facility have the resources and interest for implementing the antibiogram. It also includes checklists and other preparatory materials to support planning.
2. Phase 2. Development. This phase focuses on working with clinical laboratories and developing an antibiogram.
3. Phase 3. Implementation. This phase involves training prescribing clinicians and nurses to use the antibiogram.
4. Phase 4. Program Monitoring. This phase focuses on monitoring and evaluating the antibiogram and tracking the antibiotics prescribed.

¹Abt Associates Inc. and Brigham and Women’s Hospital. Using Nursing Home Antibiograms to Improve Antibiotic Prescribing and Delivery – Final Report. Report prepared for Agency for Healthcare Research and Quality, Contract HHSA2902006000111, Task Order No. 13; 2012.

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