Antibiotic use is common in long-term care facility (LTCF) with 70% of residents receiving at least one course of systemic antibiotic every year.  A significant proportion of the antibiotic use (40% to 75%) in nursing homes has been found to be unnecessary or inappropriate.  Antibiotic exposure drives selection for multidrug resistant organisms and C difficile infections.  The Center for Medicare and Medicaid Services (CMS) will require all LTCF to have an antibiotic stewardship program (ASP) by November 28, 2017 as part of the requirements
for participation.

Most long-term care facilities lack the experience and expertise to implement ASP.  Under the leadership of Dr. Robin Jump, the Infection Advisory Committee of AMDA – The Society for Post-Acute and Long-Term Care Medicine developed a template for antibiotic stewardship policy for post-acute and long-term care settings. 
Dr. Muhammad Salmon Ashraf, an associate professor in the Division of Infectious Diseases at UNMC, who is also a member of the Infection Advisory Committee of AMDA, also contributed in the development of this template.  This template is published in the November issue of The Journal of Post-Acute and Long-Term Care Medicine (JAMDA) and is available at http://www.jamda.com/article/S1525-8610(17)30430-9/fulltext free of charge.

According to Dr. Ashraf, LTCF can adapt antibiotic stewardship policy mentioned in this template to meet the requirements of CMS.  The template also provide some guidance on the implementation of ASP.  Another helpful part of this document is a complied list of many free resources that can be used for development of an ASP.

Dr. Ashraf, who is also the Co-Medical Director of Nebraska ASAP, pointed out that in addition to the resources mentioned in this document, LTCF can also find other helpful tools on the Nebraska ASAP website (launched after submission of this template to JAMDA).  Long-term care facilities in Nebraska should feel free to contact Nebraska ASAP with any question regarding development of antibiotic stewardship program.  The ASAP team will make every effort to provide the best guidance.

Written by Phil Chung, PharmD, MS, BCPS