Nursing Home Resources

Getting Started with Stewardship for Nursing Homes

Harms from antibiotic overuse are significant for the frail and older adults receiving care in nursing homes. According to the CDC, 40-75% of antibiotics prescribed in nursing homes may be unnecessary or inappropriate (Core Elements of Antibiotic Stewardship for Nursing Homes, CDC). Antimicrobial stewardship programs can help protect residents from harm stemming from antibiotic overuse.

The resources below are designed to assist all nursing home healthcare professionals with implementing a stewardship program.

WA DOH Implementation Resources 

• American Society of Consultant Pharmacists (ASCP) Toolkit Flyer (PDF)
  The ASCP Antimicrobial Stewardship Toolkit offers practical guidance for starting, growing, and maintaining an antimicrobial program, ensuring compliance with CMS Long-Term Care regulations. This specialized curriculum will equip you with the skills to manage antimicrobial use effectively in long-term care settings, and it’s available for free through the Washington State Department of Health.
• Antimicrobial Stewardship Toolkit
  Contains resources that can assist facilities with implementing and maintaining a stewardship program.
• Skilled Nursing Facility AMS Collaborative (PDF)
  Enhance your antimicrobial stewardship expertise and skills through WA DOH’s SNF AMS Collaborative. The collaborative will run from September 2024 – May 2025, and will consist of monthly 45-min sessions. Each session will include a concise presentation, hands-on activities, and Q&A. Benefits of participation include improved antibiotic use and survey readiness. Earn a certificate upon completion, demonstrating your enhanced stewardship expertise.
  Join the SNF AMS Collaborative

CDC Resources

• The Core Elements of Antibiotic Stewardship for Nursing Homes
  Provides guidance on creating a new stewardship program
• The Core Elements of Antibiotic Stewardship for Nursing Homes: Checklist
  Checklists based upon the Core Elements resource listed above
• The Core Elements of Antibiotic Stewardship for Nursing Homes Appendices
  • Appendix A: Policy and Practice Actions to Improve Antibiotic Use
  • Appendix B: Measures of Antibiotic Prescribing, Use, and Outcomes
  • Appendix C: Data Sources, Elements, and Measures for Tracking Antibiotic Use in Nursing Homes

Quality Improvement (QI) Tools

• Assists facilities with implementing the CDC’s Core Elements for Antibiotic Stewardship in a practical manner. These tools are designed by Comagine Health.
  • Quick QAPI Calendar
    • Assists facilities with building sustained QI efforts and support. This tool is designed to be done consistently (15 minutes per day)
  • Plan-Do-Study-Act (PDSA) Essentials and Worksheet
    • Helps facilities to plan and implement small tests of change        
  • Root Cause Analysis (RCA) Process
    • Contains a workflow outlining the steps needed to perform an RCA, along with a worksheet and example
  • Checklist for Sustaining Change
    • Aids facilities with integrating successful projects into ongoing organizational systems

Regulations & Accreditations

Centers for Medicare and Medicaid Services

• State Operations Manual

Clinical Guidance

Local Clinical Guideline Creation Guidance Document

• Best Practices for Creating Local Antimicrobial Stewardship Clinical Practice Guidelines in Healthcare Settings (PDF)
  • Created in partnership with the University of Washington’s Centers for Stewardship in Medicine (UW-CSiM), this document assists facilities with creating local guidelines

Antibiotic Treatment Guide

• UW’s Centers for Stewardship in Medicine (formerly UW-TASP) Antibiotic Guide
  • Contains evidence-based antibiotic recommendations for the treatment of common diseases

National Clinical Guidelines

• IDSA Practice Guidelines
  • Contains guidelines for common disease states such as pneumonia, skin infections, and urinary tract infections

Education

Providers

•  WA DOH & WA-PALTC’s Urine Polymerase Chain Reaction-Based (PCR) Testing Guidance Document
  • Urine polymerase chain reaction-based (PCR) laboratory testing has been promoted to clinicians as an alternative method of obtaining urine cultures. Due to the high prevalence and overuse of antibiotics for asymptomatic bacteriuria (ASB) in the post-acute and long-term setting, guidance on the topic of PCR urine testing is provided to ensure safety
• Medical Providers FAQs About Urinary Tract Infections (UTI)(PDF)
  An evidence-based document that addresses some common drivers for antibiotic prescribing for asymptomatic bacteriuria (ASB)
• WA DOH’s & WA-PALTC’s Antibiotic Stewardship of UTI in the Long-Term Care Setting Lecture Series
  • Session 1: Is it ASB or UTI? A Case-Based Approach
    • Video
    • Slides
  • Session 2: Debunking the Myths Associated with UTI
    • Video
    • Slides
  • Session 3: Go with the Flow: A Case-Based Approach
    • Video
    • Slides
  • Session 4: Implementing Antimicrobial Stewardship in a Long-Term Care Setting Panel Discussion
    • Video

All Healthcare Professionals

• CDC’s Educational Resources for Consultant Pharmacists
  Contains posters for consultant pharmacists
• CDC’s Educational Resources for Healthcare Professionals
  Contains a communication training toolkit, posters, and more
• WA DOH’s Communicating with Residents and Families About Antibiotics
  Designed to assist with communication skills around antibiotic use, which will help avoid inappropriate prescribing. This education offers free CE for nurses and medical assistants.

Data

CDC’s Antibiotic Resistance and Patient Safety Portal (ARSP)
This portal helps facilities explore and visualize national and state-specific data relevant to antibiotic stewardship and infection prevention programs

Questions and Feedback

Email us at: ams@doh.wa.gov