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Nursing Home Antimi­crobial Stewar­dship Cheat Sheet (DRAFT) by [deleted]

12 Common Nursing Home Situations in Which Systemic Antibiotics are Generally Not Indicated

This is a draft cheat sheet. It is a work in progress and is not finished yet.


At least 25 percent of antibiotic prescr­iptions in nursing homes do not meet clinical guidelines for prescr­ibing. This use and overuse of antibi­otics results in side effects and drug-r­esi­stant bacteria. The Commun­ication and Decisi­onm­aking for Four Infections toolkit aims to reduce inappr­opriate prescr­ibing for the four infections for which antibi­otics are most frequently prescribed in nursing homes:
(1) Urinary tract infections (UTIs)
(2) Lower respir­atory tract infections
(3) Skin and soft tissue infections
(4) Gastro­int­estinal infections

Determine Whether To Treat

Nursing Home Antimi­crobial Stewar­dship Guide
Toolkit 2. Common Suspected Infect­ions: Commun­ication and Decisi­onm­aking for Four Infections

Tool 3. QI Meetings Tip Sheet

Having a Quality Improv­ement (QI) Team and QI team meetings is important to succes­sfully implement and oversee progress being made
in relation to antibiotic use, infecti on control, and care practices related to commun­ication with medical care providers using the Medical Care Referral Form or MCRF) and residents and their families (using tools from the Toolkit to Educate and Engage Residents and Family Members).

Based on successful models of QI, it is recomm­ended that:

Team meetings be held monthly to review progress.
All indivi­duals respon­sible for the QI program attend the meetings.
A team leader be identified who is respon­sible to:
Provide an update on progress:
 ­ ­ ­  how often the MCRF has been used.
 ­ ­ ­  reviewing changes based on the infection log.
Convene the meetings and review inform­ation from the last month.
Follow-up on matters identified during the meeting.
Train or delegate training new staff in the Common Suspected Infect­ions: Tools to Improve Commun­ication and Decision making toolkit.
Work with staff to assure that all current residents and families, new residents, and those consid­ering hospice receive inform­ation about antibi­otics. Sample inform­ation tools are provided in the Toolkit to Educate and Engage Residents and Family Members.

Meeting Consid­era­tions

Who will complete the MCRF
When monthly meetings will be held

Where Systemic Antibi­otics Generally Not Indicated

12 Common Nursing Home Situations in Which Systemic Antibi­otics are Generally Not Indicated

1. Positive urine culture in an asympt­omatic resident.
2. Urine culture ordered solely because of change in urine appear­ance.
3. Nonspe­cific symptoms or signs not referable to the urinary tract, such as falls or mental status change (with or without a positive urine culture).
4. Upper respir­atory infection (common cold).
5. Bronchitis or asthma in a resident who does not have COPD.
6. “Infil­trate” on chest x-ray in the absence of clinically signif­icant symptoms.
7. Suspected or proven influenza in the absence of a secondary infection (but DO treat influenza with antivi­rals).
8. Respir­atory symptoms in a resident with advanced dementia, on palliative care, or at the end of life.
9. Skin wound without cellul­itis, sepsis, or osteom­yelitis (regar­dless of culture result).
10. Small (<5cm) localized abscess without signif­icant surrou­nding cellulitis (drainage is required of all absces­ses).
11. Decubitus ulcer in a resident at the end of life.
12. Acute vomiting and/or diarrhea in the absence of a positive culture for shigella or salmon­ella, or a positive toxin assay for Clostr­idium difficile

Core Elements of Antibotic Stewar­dship