Toolkit 2. Using Nursing Home Antibiograms To Choose the Right Antibiotic (Concise Antibiogram Toolkit)
Toolkit Effectiveness
When an antibiogram was implemented in nursing homes, results suggested that it had an effect on antibiotic prescribing. For example, Ciprofloxacin was prescribed 15% of the time versus 22% of the time during the initial chart review period. Also, Cefuroxime was prescribed 14% of the time, up from 3% during the initial chart review period.1
Overview of the Toolkit
What Is an Antibiogram and Why Should a Nursing Home Use It?
A nursing home-specific antibiogram may be an effective and inexpensive tool for improving appropriate antibiotic prescribing. An antibiogram is a report that displays the organisms present in diagnostic clinical specimens that nursing homes send for laboratory testing—aggregated across all residents suspected of having an infection during a certain time period—along with the susceptibility of each organism to various antibiotics. Referring to an antibiogram report enables prescribing clinicians to make prompt, empirically based decisions. Because antibiograms provide information on local susceptibility patterns, they may improve the use of antibiotics in nursing homes by helping prescribing clinicians select appropriate therapies for residents with suspected infections.
What Is the Concise Antibiogram Toolkit?
The Concise Antibiogram toolkit aims to guide nursing homes in creating and maintaining their own antibiograms. Six tools are included in the Concise Antibiogram toolkit:
- A Background guide to antibiograms: Explains what they are and what they do (tool 1) (PDF | Word)
- Getting Started: Explains the sources of data for creating antibiograms (tool 2) (PDF | Word)
- Using WHONET: Provides instructions on using free database software to create an antibiogram (tool 3) (PDF | Word)
- How to Enter Data Manually Into an Antibiogram Template: Explains how to create an antibiogram using WHONET results (tool 4) ( PDF | Word)
- An Antibiogram Template: A sample format for entering culture results (tool 5) (PDF | Word | Excel)
- A Data Entry Form: For manually recording culture data from medical charts (tool 6) (PDF | Word | Excel)
How Do I Implement the Concise Antibiogram Toolkit?
Implementing the Concise Antibiogram toolkit involves four steps:
- Identify champions. Champions help drive successful implementation by increasing staff awareness of tools, building support among leadership and nursing home staff, and monitoring antibiogram results. It is helpful to have at least two champions at the nursing home to make sure that an antibiogram is created and distributed even if there is staff turnover. These champions can be the director of nursing, assistant director of nursing, administrator, charge nurses, and/or the medical director.
- Develop the antibiogram. The toolkit provides instructions on how to create the antibiogram.
- Distribute the antibiogram Antibiogram distribution should be accompanied with instructions for use and interpretation. Importantly, each nursing home is different and nursing home leadership will need to determine the best way to distribute information to prescribing clinicians and nursing home staff.
- Update the antibiogram. Updating the antibiogram annually will help maintain its value.
1Denver Health and the University of Maryland School of Medicine. Using Nursing Home Antibiograms to Improve Antibiotic Prescribing and Delivery. Report prepared for Agency for Healthcare Research and Quality, Contract 290-2006-00-20, Task Order No. 9; 2012.
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