Nearly 2 million Americans are sickened every year due to antibiotic resistance. In the U.S. alone, inappropriate use of antibiotics has contributed to $21B–$41B in rising healthcare costs1. To help curb this growing trend, antibiotic stewardship programs (ASPs) are becoming a top priority among some pharmacy leaders.

For long-term care facilities (LTCFs), ASPs offer a host of benefits ranging from improved patient health and public safety to cost savings. As a partner to LTCFs, it is important to understand the underlying causes of antibiotic resistance, the current and future impact on your patient population, and the role your pharmacy can play in supporting an effective ASP.

Antibiotic Stewardship Programs

Antibiotic resistance on the rise

More than 4 million Americans currently reside in LTCFs, and the Centers for Disease Control and Prevention (CDC) estimates that 50–70% percent of them receive some type of antibiotic treatment every year.2,3 Although antibiotics play an important role in improving the health of this patient population, some drugs are unnecessarily or inappropriately prescribed. As a result, we are seeing an increase in antibiotic resistance in the treatment of issues like urinary tract infections (UTIs), diarrheal diseases and staph infections. In addition, patients are suffering adverse effects leading to longer, more expensive hospital stays.

Opportunities for your pharmacy

According to the U.S. Department of Health and Human Services’ Administration on Aging, the population of those 65 years and older is expected to nearly double by 20504. Based on that projection, your LTC pharmacy is well positioned to help enhance the quality of care for seniors through the safe use of medications not only now, but also in the years ahead. In addition, changes across the continuum of care including new performance-based payment models mean that hospitals will continue to look toward LTCFs to help improve patient outcomes and reduce readmissions. As a result, long-term care pharmacists will continue to play an important role in helping to ensure that the right medications are delivered to the right patients at the right time.

Your role in antibiotic stewardship

Currently, there are no federal mandates requiring the implementation of ASPs. For some long-term care pharmacies, antibiotic stewardship tends to focus on obtaining accurate culture and sensitivity data along with stop dates–both of which are the basis for regulatory review by pharmacy-based state inspectors5. At the same time, there is a significant emphasis on antibiotic utilization. This typically includes ensuring the appropriate therapy and dosage of oral antibiotics, which are commonly used to treat UTIs, Clostridium difficile and upper respiratory issues, and intravenous antibiotics, which help to treat soft tissue infections like decubitus ulcers.

Other ways your pharmacy can help reduce drug resistance and support ASPs include:

  • Offer education and counseling–Provide your staff with infectious disease training. In addition, consider counseling your customers on appropriate antibiotic use and adherence.
  • Open lines of communication–Have dedicated personnel responsible for communicating directly with patients and their caregivers to ensure the proper handling, storage and use of medications.
  • Monitor and analyze antibiotic usage–With the right tools and technology, you can track antibiotic usage and resistance along with your drug spend. This information will allow you to better identify trends and opportunities for improvement.
  • Establish policies and protocols–Based on the information and best practices that you have collected, you can develop clear guidelines for diagnosis and treatments6.

Where to find additional information

To learn more about antibiotic stewardship, including examples of successful programs, visit the CDC’s Get Smart website. The American Hospital Association also offers a host of online resources including an Antimicrobial Stewardship Toolkit to help LTCFs and hospitals start and maintain a program. Last, the CDC’s National Healthcare Safety Network provides a system to report infections.

Key Facts

  • Antibiotics cost LTCFs between $38M–$137M a year2
  • Approximately 25–75% of antibiotics in nursing homes are misused7
  • The population of those 65 years and older will reach 72 million by 20304

Questions to Consider

  • How can my pharmacy support antibiotic stewardship?
  • Am I using the right tools to identify antibiotic utilization trends?
  • How will antibiotic resistance impact patients in LTCFs?

12013 Antibiotic Resistance Threats in the U.S., CDC, July 17, 2014
2Get Smart for Healthcare–Antibiotic Use in Nursing Homes, CDC, March 3, 2014
3Nursing Homes and Assisted Living (Long-Term Care Facilities), CDC, January 27, 2015
4Projected Future Growth of the Older Population, Department of Health and Human Services, Administration on Aging, June 23, 2010
5State Operations Manual Appendix PP–Guidance to Surveyors for Long Term Care Facilities, Centers for Medicare and Medicaid Services, February 6, 2015
6Get Smart for Healthcare–Core Elements of Hospital Antibiotic Stewardship Programs, CDC, March 4, 2014
7Antibiotic Stewardship Programs in Long-Term Care Facilities, Annals of Long Term Care, April 12, 2011

Note: The information provided here is for reference only and does not constitute legal advice. We make no representations with regard to the content’s comprehensiveness. You are solely responsible for investigating and complying with all applicable laws that govern the operation of your business.


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