Long-Term Care Antimicrobial Stewardship

Briefly describe your daily antimicrobial stewardship practices

As a consultant pharmacist for a long-term care (LTC) pharmacy, my daily antimicrobial stewardship practice centers around performing retrospective reviews of antimicrobial therapy via monthly Medication Regimen Review (MRR). Pharmacist interventions used in this setting span a large range and include everything from helping nursing staff audit their own adherence to antimicrobial stewardship program (ASP) policies, to writing correspondence to prescribers asking for review of potentially inappropriate antimicrobial prescribing. Most of my communication with prescribers centers around ensuring appropriate criteria were met to initiate an antimicrobial or asking for review of therapy with durations longer than recommended by guidelines. I also utilize pharmacy software to compile and maintain a database of antimicrobial starts and days of therapy (DOT) per 1000 resident days on behalf of each of our clients in compliance with the Tracking CDC core element of stewardship. Outside of the MRR and tracking, my services can vary greatly from month to month depending on what each facility is working on with their ASP. I have been involved in everything from presenting trends identified in prescribing during quality improvement meetings to helping Infection Preventionist nurses with implementation of facility-specific interventions to help reduce inappropriate antimicrobial use.

What outpatient stewardship initiative are you most proud of that you have participated in or led?

I am most proud of our pharmacy’s joint project with a local hospital system to establish that Consultant Pharmacists can play a large role in the implementation and management of LTC facility ASP’s. Changes to the Centers for Medicare and Medicaid (CMS) Rules of Participation (ROP) in 2017 added the requirement for LTC facilities to have an ASP. This presented a challenge for many of our clients, and as their pharmacy services provider we wanted to be a part of the solution. Collaborating with a local outreach team of Infectious Disease (ID) physicians and pharmacists, we built a suite of services that our pharmacy could provide clients to meet this new requirement. Over the course of a year at participating facility partners, we implemented ASP meetings, infection specific assessment and communication tools, and provided antimicrobial use tracking data. We also increased our consultant pharmacist team’s ID knowledge through a series of lectures from our collaborators and developed some new ASP specific templates for use in correspondence with LTC providers. At the end of the study, the tracking data showed statistically significant changes of increased CDC core element implementation, as well as decreased antimicrobial starts and DOT per 1000 resident days. The interventions from this study still make up the framework of what we offer to our clients today.

What does "Being Antibiotics Aware" mean to you?

I feel a strong obligation to spread the message of Antimicrobial Stewardship as a pharmacist. Our professional mission is to ensure medications are used in the safest and most appropriate manner possible. Unfortunately, antibiotics carry a higher than average risk of adverse effects, which should spur a higher level of concern when working with them. Outside of the inherent risks of antibiotic therapy for individual patients, I also cannot ignore the importance of conservation to our world today. For me professionally, the idea of conservation means I feel the need to make an impact in preserving the efficacy and safety of antimicrobials for future generations. Antibiotics are one of the few medication resources that no matter what we do, will likely lose their utility over time due to the constant natural selection of resistant microbes. My hope is that by sharing my passion for antimicrobial stewardship, together our industry and our profession can be a part of the solution to rising antimicrobial resistance.

What is one pearl you have for all clinicians to help them be antibiotic stewards?

Always be on the lookout for opportunities to make an impact. There is always something that can be done in any practice setting, and we need leaders in each setting to show the way forward. In a field as rapidly changing as ID and antimicrobial stewardship, there is a constant stream of new challenges and new opportunities. I had no idea when I started as a pharmacist intern at an LTC pharmacy that I’d have an opportunity to use my passion for antimicrobial stewardship on a daily basis, but I didn’t hesitate when the opportunity presented itself. We all have the skills and knowledge to make an impact, so be an opportunist when the chance comes your way! It is going to take all of us to working together to make antimicrobial stewardship as successful as it can be!

Alex Neukirch, PharmD

Consultant Pharmacist

Community Pharmacy a Consonus Healthcare Company