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The CMS (Center For Medicare and Medicaid Services) Antibiotic Stewardship Program for Nursing Homes and long-term care facilities went into effect in November 2017.

This new drug policy intends to curb the widespread overuse of antibiotics across nursing homes and other long-term care facilities. Antibiotics are the most frequently prescribed medication in nursing homes, and studies show that 40% to 75% of such prescriptions are inappropriate, according to the Centers for Disease Control and Prevention. This has contributed in part to antibiotic resistance, and is a global health concern as per the United Nations.

CMS: Implementing The Program

Implementing antibiotic stewardship programs at long-term care facilities requires a significant culture change. Physicians have to amend their prescribing patterns, pharmacists must diligently monitor prescription data, and nurses need to watch out for any changes in patients’ conditions.

But studies also  show stewardship programs are an effective way to lower infections in healthcare facilities. A 2016 study found stewardship programs at acute-care hospitals, which have have been required by the CMS since June 2016 to have a program, caused a 4.5% decrease in bacterial infection rates and length of stay fell by 8.9%. The programs also save providers money. The study found costs associated with antibiotics fell by 33.9%.

The American Health Care Association, which represents about 13,500 long-term care facilities across the country, has created educational tools and resources to help its members comply with the requirement.

The organization has developed online training programs including one specifically designed to train infection preventionists. By November 2019, the CMS will require all long-term care providers to have a person solely dedicated to the prevention and control of infections among patients.

CMS: Antibiotic Monitoring

The CMS also requires acute-care hospitals to have stewardship programs. Hospitals typically have specialty infectious disease doctors and lab testing on-site. Stewardship programs often use labs to culture infectious organisms so technicians can determine what antibiotics are appropriate for treatment or if no antibiotic will help.

At long-term care facilities, physicians usually only visit a few times a week to check in on their patients. Lab testing is also resourced out. Because of these circumstances, long-term care facilities have to improvise to make the programs work.

Nurses have also been critical to the program’s success. They monitor patients’ vitals closely to ensure the patient is OK without an antibiotic. They even explain to families the facility’s approach. Sometimes it’s hard for families to understand why an antibiotic isn’t being given. Families receive educational sessions and materials so they know about the stewardship program.

For example, overall, Urinary tract infections decreased from 4.33% of patients in 2015 down to zero in the fourth quarter of 2017.