Tracking antibiotics in LTC
There was a rare celebration yesterday in the world of public health: The World Health Organization declared an official end to the deadliest Ebola outbreak on record, which killed at least 11,000 people.
But the good news also serves as a reminder of the need for better infection prevention and management in healthcare.
I'll be the first to admit that I glanced over the part of the Centers for Medicare & Medicaid Services “mega rule” that said “We propose specific requirements related to the use of psychotropic drugs, § 483.45(e), and antibiotics, § 483.80(a)(2).” Earlier this week, Alliance for Aging Research head Sue Peschin argued that CMS needs to do a better job educating — and regulating — nursing homes on infection control. One of her suggestions is mandating the Core Elements of Antibiotic Stewardship for Nursing Homes.
Putting aside both my sympathy for providers chafing at the prospect of more regulations, and the practical implications of such a mandate, there's a specific part of the plan worth evaluating. It's on how antibiotic use — much like psychotropic drugs — is tracked.
There's no question many long-term care residents receive antibiotics appropriately, whether it's to treat community-acquired pneumonia or a specific infection. But while 70% of residents receive one more more courses of systemic antibiotics in a given year, somewhere between 40% to 75% of those drugs prescribed may be unnecessary or inappropriate, according to the CDC. The most common cause is misdiagnosed urinary tract infections.
Long-term care providers know how antibiotic overuse can lead to C. difficile, not to mention adverse drug events. But even with the best efforts, such as hand-washing campaigns, there's only one way to show you are marking progress: Similar to so much in LTC these days, it relates to tracking and showcasing your data.
Antibiotic use has to be tracked, and not only through a prevalence survey. Clinical management should know when antibiotics start and how days of therapy are calculated. Interventions related to antibiotics need to be documented.
We may not know yet the type of new regulations coming in the next year related to antipsychotics or antibiotics, but we can be certain there will be more scrutiny. The benefit to nursing homes jumping onto tracking antibiotic use is not only being able to run ahead of federal regulations, but also to have it as part of the package related to hospital partnerships.
If I were a hospital administrator, reducing antipsychotics would feel expected at this point. But a nursing home that shows me it knows what it's doing with antibiotics would get my ear.
Expansion of electronic health records in nursing homes is one way we'll see more of this data, but the system also has to integrate pharmacy and lab data. It also has to “make antibiotic use and resistance data to inform stewardship efforts more accessible to facility staff and leadership.” In other words, every time someone tells you about how nurses or clinical leaders will get an alert if X, Y or Z happens, make sure you ask how the system is tracking antibiotics.
We also can change how we think about antibiotics. I grew up in an era where I received tons of antibiotics related to sinus infections, and eventually I needed surgery. I cringe when I see my friends push for a prescription for their own sinus infection when it could be a cold, or for an unnecessary prescription for their child.
Let us glory in living in a time when antibiotics can save us from death related to infection, but let us also recognize that they are not to be trifled with.
Elizabeth Leis Newman is Senior Editor at McKnight's. Follow her @TigerELN.