Toolkit 1. Start an Antimicrobial Stewardship Program

Overview of the Toolkit

Why Should a Nursing Home Use This Toolkit?

This toolkit provides nursing homes with a simple, step-by-step approach to starting an antimicrobial stewardship program. An antimicrobial stewardship program uses collaborative and evidence-based approaches to improve antibiotic use by getting residents the right antibiotics, when they need them. The program is aligned with and supports Quality Assurance and Performance Improvement (QAPI) practices, such as supporting governance and leadership, feedback and monitoring. In addition, an antimicrobial stewardship program can support a nursing home’s infection control program (Federal Tag 441).

This toolkit also includes the components that research shows are necessary for successful implementation of antimicrobial stewardship program. The benefits of creating an antimicrobial stewardship program include improved quality of care for residents, reduced risk of infections from resistant organisms, and reduced health care costs.

Where Can Nursing Homes Find More Information and Practical Training on Antimicrobial Stewardship Programs?

The CDC provides information in its Core Elements of Antibiotic Stewardship for Nursing Homes guide. It includes

• Overviews of major topics in antimicrobial stewardship.
• Detailed guide to policy and practice aspects of stewardship.
• Detailed information on measures of antibiotic prescribing, use, and outcomes.

Improving Infection Assessment Course provides long-term care staff with knowledge and skills to change their practices and to drive change in facility-level practices, related to identifying and treating infections in older adults. This will be measured through pre and post-tests. Earn 3.25 CEU, CME, or ACPE Contact Hours on completion. The course is hosted by the New England Quality Innovation Network-Quality Improvement Organization. To register, select the course title above or go to www.learningforquality.org and select Register. Then fill in the form on the next page, select Get Started, and follow the instructions in the account confirmation email.

The Promoting Wise Antibiotic Use in Nursing Homes program is available from the University of North Carolina at Chapel Hill. It provides

• Training modules for nurses, with CE credit available. Training is available to any nurse in the US free of charge
• Podcasts for medical providers, also with CE credit available
• Educational brochures for patients, families, and nursing assistants

What Is the Start an Antimicrobial Stewardship Program Toolkit?

This toolkit is designed to help a nursing home select, plan for, introduce, and implement an antimicrobial stewardship program. The toolkit includes the following tools:

• Suggestions for how to Gather a Team to oversee the antimicrobial stewardship program (tool 1) (PDF | Word)
• Roles and Responsibilities to track team membership, roles, and responsibilities (tool 2) (PDF | Word)
• A Readiness Assessment to help determine what the nursing home is prepared to undertake (tool 3) (PDF | Word)
• An Implementation Planning Sample Agenda for the team to plan for the program (tool 4) (PDF | Word)
• Draft Policies and Procedures for the Antimicrobial Stewardship Program, including a sample policy letter and sample procedure letter (tool 5)  (PDF | Word)

How Is the Toolkit Implemented?

Implementing the toolkit involves four steps:

1. Identify champions and gather a team. If this has not already been done, identify at least two champions—that is, staff who will lead the overall activity. This may include the infection control nurse (infection preventionist), charge nurses, assistant director of nursing, the director of nursing, and, if possible, the medical director or a prescribing clinician. The medical director need not serve as a champion but still plays a critical role in supporting and participating in the effort. Champions help drive successful stewardship by increasing staff awareness of antibiotic use, building support among leadership and nursing home staff, and monitoring the results of a stewardship program. It is helpful to have at least two champions at the nursing home to help ensure continued leadership should staff change. Champions should gather an antimicrobial stewardship program team to lead and monitor stewardship in the nursing home. Tool 1 (Gather a Team) provides a step-by-step guide to creating an antimicrobial stewardship program team.
    
2. Conduct a readiness assessment. The Readiness Assessment (tool 3) will help the antimicrobial stewardship program team determine what it needs and how ready it is to undertake a new intervention. There are several stewardship toolkits and tools available in this Guide, but each nursing home has different needs, priorities, and resources. Conducting a readiness assessment is a useful way for the team to determine what stewardship goals are reasonable and which tools have the best chance of success in each nursing home. If the nursing home wants to use more than one toolkit, it may be beneficial to implement them one at a time.
    
3. Plan for implementation. The antimicrobial stewardship program team should develop a timeline, responsibilities, a budget, and a schedule for team meetings. The team must consider the nursing home’s unique characteristics, needs, and resources, and think about specific items—such as costs for supplies and staff time—that will be needed to carry out the antimicrobial stewardship program. For instance, can existing resources and workflows be adapted to meet the needs of the program, or will new materials or procedures be needed? A sample meeting agenda (tool 4) can be used to guide team discussion and planning. Sample policies and procedures (tool 5) are included to reinforce the new activities and make them part of the standard workflow.
    
4. Introduce new policies and procedures to staff. Communicate the new procedures to staff in a clear, easy-to-understand manner. Include information about the timeline for implementing the program and include a copy of the policies or procedures. Depending on the scope of the new procedures, training for staff and prescribing clinicians may also be needed. Tool 5 presents letter templates for communicating this information to nursing home staff.

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