Minnesota Antibiotic Stewardship
Long-term Care Honor Roll

Current Minnesota Antibiotic Stewardship Long-term Care Gold Level Honor Roll Honorees

Aitkin Health Services

• Antibiotic Stewardship Leaders: Shelly Hanneken, Administrator and Cindy Larson, Infection Prevention and Control Officer
• Highlighted Antibiotic Stewardship Action: Aitkin Health Services uses an antibiotic stewardship software to track antibiotic use and resident infections. Antibiotic use is reviewed monthly with the consulting pharmacist.
• Highlighted Collaborative Activity: Aitkin Health Services collaborates with the local hospital to implement common strategies to reduce healthcare-associated infections, advance antibiotic stewardship efforts, and improve resident outcomes. Each care transition involves verbal communication, and the Director of Social Services attends a local transitional care collaboration meeting to discuss and review antibiotic usage, physician education, and steps to ensure appropriate implementation.

Bethany On The Lake

• Antibiotic Stewardship Leaders: Brittany Schmidt, RN, Infection Preventionist, Debra Buke, RN, Director of Nursing, and Jessica Kelly, RN
• Highlighted Antibiotic Stewardship Action: With each antibiotic that is prescribed, nurses use a scripted antibiotic time-out form to review antibiotic details with the provider within 72 hours of the prescription.
• Highlighted Collaborative Activity: Bethany on the Lake has collaborated with area hospitals to ensure that antibiotic time-outs are performed by the prescribing provider before a patient is discharged to the facility.

Carris Health Care Center

• Antibiotic Stewardship Leaders: Christina Jurgenson, BSN, RN, Infection Preventionist and Amanda Thorson, MSN, RN, Director of Nursing
• Highlighted Antibiotic Stewardship Action: Carris Health Center participates in the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use in Long-term Care.
• Highlighted Collaborative Activity: Christina Jurgenson, RN, Infection Preventionist, developed an interactive tool for nurses to use to determine if resident symptoms meet Loeb criteria for infection. This tool has been shared with Rice Memorial Hospital prescribers, Affiliated Community Medical Center prescribers, CentraCare long-term care facilities infection control staff, and a long-term care facility in the community in order to increase their antibiotic stewardship efforts.

Catholic Eldercare

• Antibiotic Stewardship Leaders: Marilyn DuBay, Infection Control Practitioner, John Mielke, MD, and Chris Johnsen, Infection Preventionist
• Highlighted Antibiotic Stewardship Action: Catholic Eldercare is part of the Care Choice grant. This grant developed a brochure on antibiotic stewardship which is included in all admission folders and continues to be available in each lobby in the skilled nursing facility.
• Highlighted Collaborative Activity: Through the Care Choice grant, Catholic Eldercare established connections with 16 other long-term care facilities. Feedback regarding antibiotic stewardship programs is shared to ensure a robust antibiotic stewardship program exists.

CentraCare Health—Long Prairie Care Center

• Antibiotic Stewardship Leaders: Jennifer Massicotte, RN and Rene Eldidy, Medical Director
• Highlighted Antibiotic Stewardship Action: CentraCare Health-Long Prairie Care Center uses a SBAR UTI Form to gather and communicate information regarding possible UTI symptoms. This form is faxed to providers to get order for UA/UC or other orders and uses a UTI symptom protocol to avoid treating asymptomatic bacteruria and/or ordering unnecessary UA/UCs for “possible” urinary symptoms.
• Highlighted Collaborative Activity: CentraCare Health-Long Prairie Care Center provides hospital, clinic, and ER providers with surveillance definition criteria and a Situation, Background, Assessment, and Recommendation (SBAR) form as these providers regularly see residents and may prescribe antibiotics. This ensures providers are aware of CentraCare Health-Long Prairie Care Center’s efforts related to antibiotic stewardship and ensures proper transitions of care.

CentraCare Health—Monticello Care Center

• Antibiotic Stewardship Leaders: Dr. Glenn Nemec, Medical Director and Natalie Karg, Infection Preventionist
• Highlighted Antibiotic Stewardship Action: CentraCare Health Monticello utilizes the Infection and Antibiotic Use Tracking Tool to monitor antibiotic starts, whether or not criteria are met for proper initiation of an antibiotic, and trends. Cases that do not meet the antibiotic use criteria are sent to the Medical Director for review and potential intervention.
• Highlighted Collaborative Activity: CentraCare Health Monticello collaborates with emergency department providers in the adjoining hospital providing information regarding the Antibiotic Use Protocol-Minimum Criteria for Initiation of Antibiotics in Long-term Care Residents. The emergency department Medical Director reviews cases that do not meet criteria as determined by the Care Center Medical Director.

CentraCare Health—Sauk Centre Care Center

• Antibiotic Stewardship Leaders: Sharon Whalen, Infection Prevention and Control and Agnes Bearson, Director of Nursing
• Highlighted Antibiotic Stewardship Action: CentraCare Health-Sauk Centre Care Center utilizes the Infection and Antibiotic Use Tracking Tool to monitor catheter-associated urinary tract infections (CAUTI). The tracking tool tracks the type of infection, culture information, antibiotic prescriptions, and devices which is reviewed monthly and/or sooner if concerns arise.
• Highlighted Collaborative Activity: CentraCare Health-Sauk Centre Care Center collaborates with CentraCare sites located in Melrose, Long Prairie, Paynesville, Monticello, and St. Cloud to ensure that a system-wide antibiotic stewardship policy is in place. Work groups meet on a monthly basis and share lab information to develop a share antibiogram.

Cuyuna Regional Medical Center

• Antibiotic Stewardship Leaders: Sheila Miller, Director of Nursing and Sarah Dorschner, Infection Prevention and Control
• Highlighted Antibiotic Stewardship Action: Cuyuna Regional Medical Center utilizes a line list to track all antibiotics prescribed, reason for prescription, testing performed, symptom resolution, prescribing physician name, and 72-hour antibiotic time out status.
• Highlighted Collaborative Activity: Cuyuna Regional Medical Center collaborates with the hospital, clinic, and emergency department to ensure antibiotic stewardship expectations remain consisted across multiple care settings. All care areas meet on a regular basis to establish a strong antibiotic stewardship program within Crosby, Minnesota.

Essentia Health First Care Living Center

• Antibiotic Stewardship Leaders: Lori Hand, RN and Marilyn Sundquist, RN, DON
• Highlighted Antibiotic Stewardship Action: Nursing care plan templates were developed to streamline the antibiotic/infection care planning process and to include non-pharmacologic and nursing interventions as well as to standardize a three-day antibiotic time-out process.
• Highlighted Collaborative Activity: First Care Living Center has an annual skills fair with staff from long-term care, assisted living, home health and hospice, nutrition services, environmental services, therapeutic recreation, the clinic, and the hospital where information on the C. difficile initiative, antibiotic stewardship, and infection control is presented to staff in an interactive environment.

Essentia Health Grace Home

• Antibiotic Stewardship Leaders: Hannah Maanum, RN and Haley Zimmel, Director of Nursing
• Highlighted Antibiotic Stewardship Action: Essentia Health Grace Home adopted the Minnesota Antimicrobial Stewardship Toolkit for Long-term Care Facilities Infection Surveillance Definitions. Additionally, Essentia Health Grace Home is currently in the process to adopt the MDH Infection and Antibiotic Use Tracking Tool with an expected roll out date of May 1, 2019.
• Highlighted Collaborative Activity: Essentia Health Grace Home’s infection preventionist continually works with Essentia Health Graceville Hospital and Clinic to promote the core elements of a successful antibiotic stewardship program across care settings.

Essentia Health Northern Pines Care Center

• Antibiotic Stewardship Leaders: Laurie O'Laughlin, Director of Nursing, Infection Preventionist and Melissa Plesha, RN, MDS Coordinator
• Highlighted Antibiotic Stewardship Action: Infection preventionists at Northern Pines Care Center utilize a “pathway” form to guide appropriate prophylactic antibiotic use and consult with an infectious disease physician when appropriateness of prophylactic use is in question. This has reduced prophylactic use across a three-facility collaborative by over 50%.
• Highlighted Collaborative Activity: Northern Pines Care Center is the lead of three institutions in a collaborative Performance-based Incentive Payments Project (PIPP) grant from the Department of Human Services, one component of which is providing education to all staff in the three collaborative facilities.

Essentia Health Oak Crossing

• Antibiotic Stewardship Leaders: Stacie Urbanick, RN and Jackie McKenzie, RN
• Highlighted Antibiotic Stewardship Action: Oak Crossing has successfully used antibiotic time-outs to decrease antibiotic treatment duration and to discontinue antibiotics if minimum criteria for the initiation of antibiotics are not met. Nursing staff use the MDH Infection and Antibiotic Use Tracking Tool to track symptom management and antibiotic use.
• Highlighted Collaborative Activity: Essentia Health Oak Crossing participates in a local collaborative for antibiotic stewardship. Collaborative participants include staff from the local acute care hospital, three long-term care facilities, two ambulatory care clinics, and a dialysis center. The Collaborative meets quarterly and holds monthly working group calls. Collaborative goals include improvement of antibiotic management during care transitions and education of patients, residents, families, and the public on antibiotic stewardship.

Essentia Health Virginia Care Center

• Antibiotic Stewardship Leaders: Deborah Morell, Director of Nursing and Michelle Korva, MDS/Restorative Manager
• Highlighted Antibiotic Stewardship Action: Essentia Health Virginia Care Center actively tracks all resident and staff infections by compiling all staff call-in slips and tracking all reported infections, areas where infected staff members work, and noting if residents have related infections. Additionally, antibiotic prescribing is tracked by provider, noting if it is in hospital setting prior to admission, the emergency room (ER), or a nurse practitioner.  
• Highlighted Collaborative Activity: Essentia Health Virginia Care Center is in collaboration with regional Essentia Health long-term care facilities for a performance-based incentive payment program (PIPP) project related to infection prevention and antibiotic stewardship. Data is shared with Northern Pines in Aurora and Homestead in Deer River through routine meetings. Additionally, Essentia Health Virginia Care Center focuses on successful transitions of care when a resident transfers to another facility such as a nursing home, hospital, or back home by sharing essential infection-related information during discharge planning.

Glencoe Regional Health Long Term Care (GlenFields)

• Antibiotic Stewardship Leaders: Melanie Schoenfeld, RN, Infection Preventionist and Amy Dittmer, Director of Pharmacy
• Highlighted Antibiotic Stewardship Action: Glencoe Regional Health Services reviews diagnostic culture reports to determine if a prescribed antibiotic can be stopped or adjusted. Antibiotic monitoring forms are audited to ensure adherence to nurse-driven protocols, and real-time feedback is provided to nursing and prescribing staff.
• Highlighted Collaborative Activity: Glencoe Regional Health Long Term Care (GlenFields) collaborates with Glencoe Regional Health Hospital to maintain a robust antibiotic stewardship program and ensure best practices. Regular meetings ensure that elements for a successful antibiotic stewardship program are being met. These meetings also facilitate shared education opportunities such as learning modules and outcome data review and feedback. Tools are used for communication across care transitions. Hospital pharmacists are available to review susceptibility results for resident urinary pathogens.

Granite Falls Health Care Center

• Antibiotic Stewardship Leaders: Dawn Huelsman, Director of Nursing, Vice President and Shelby McNeil, RN, Infection Preventionist
• Highlighted Antibiotic Stewardship Action: Granite Falls Health Care Center has implemented criteria-based monitoring with each antibiotic administered. Staff, providers, residents, and family members have all been provided education on antibiotic stewardship and we work together to make sure the proper criteria is met for each antibiotic prescribed. When an antibiotic is ordered, the infection preventionist completes the monitoring record based upon available documentation. If criteria is not given at the time of the order, calls are placed to the provider to request this information. A committee meets routinely to monitor our data findings and to oversee our infection control practices and surveillance for all departments.
• Highlighted Collaborative Activity: Granite Falls Health collaborates with Granite Falls Health Clinic to ensure proper transitions of care when a resident receives an antibiotic prescription. Additionally, Granite Falls Health collaborates with their ambulance service through a program called “Community Paramedic” which reaches the public with complex medical needs.

Guardian Angels Health and Rehabilitation Center

• Antibiotic Stewardship Leaders: Bobbie Radaich, RN, DON, IPCO and Sheila Sandberg, RN, ADON
• Highlighted Antibiotic Stewardship Action: The infection control nurse uses a computer-based system to track antibiotic use. Infection data are compiled daily, and antibiotic use is reviewed monthly with the Quality Assurance Process Improvement committee and weekly during interdisciplinary team meetings.
• Highlighted Collaborative Activity: Guardian Angels Health and Rehabilitation Center nurses collaborate with the Hibbing Area Clinics to enhance communication with primary care providers, through use of an SBAR form and by participation in physician rounds for residents. The objectives are appropriate use of antibiotics and improvement of antibiotic prescribing outcomes.

Knute Nelson

• Antibiotic Stewardship Leaders: Mandi Ellerbrok, Infection Preventionist, RN, BSN and Pat Perryman, RN, DON
• Highlighted Antibiotic Stewardship Action: A three-day antibiotic time out is completed once antibiotic is started. If antibiotic is red flagged per time out, the physician is notified and needed to review current antibiotic.
• Highlighted Collaborative Activity: In quarterly QAPI meetings, antibiotic use is reviewed with the Medical Director and consulting pharmacist. If inappropriate antibiotic use is found while gathering/discussing data, the Medical Director takes the information to the clinic and Chief Medical Officer to discuss findings so further education can be provided to prescribing providers. Additionally, we collaborate with home care agencies upon discharge for patient's antibiotic use and other interventions during in-patient/long-term stay.

Lakewood Health System Care Center

• Antibiotic Stewardship Leaders: Katie Paine Santos, RN, ADON and Kendra Peterson, BSN
• Highlighted Antibiotic Stewardship Action: Through regular antibiotic time-outs with APC rounds and rounding MDs, Lakewood Health System Care Center has effectively shortened the duration of antibiotic prescriptions and discontinues antibiotic treatment when cultures return no growth.
• Highlighted Collaborative Activity: Lakewood Health System Care Center collaborates with other long-term care facilities in their region to share information regarding MRSA rates in their facility. This data is reported back to the Lakewood Health System work group on antibiotic stewardship to determine how providers treat healthcare-associated pneumonia and the antibiotics used in treatment.

Mayo Clinic Health Systems—Lake City Care Center

• Antibiotic Stewardship Leaders: Connor Hinrichs, RN, Director of Nursing and Katie Fadell-Mann, RN, Infection Preventionist
• Highlighted Antibiotic Stewardship Action: Mayo Clinic Health Systems–Lake City Care Center uses an antibiotic timeout checklist for residents. A situation-background-assessment-recommendation (SBAR) form is completed by nurses within 72 hours of an antibiotic initiation, for review by the primary physician. The SBAR includes information about the antibiotic order, diagnostic results, signs and symptoms of illness, and any "red flags," such as antibiotic duration greater than seven days or no culture results available. The provider and infection preventionist are notified of "red flags."
• Highlighted Collaborative Activity: Antibiotic use data are shared quarterly with other facilities, with the goal of setting benchmarks for antibiotic use in long-term care centers. Antibiotic name, class, dose, route, provider, total days of therapy, and whether Loeb criteria were met are tracked by each facility.

McIntosh Senior Living

• Antibiotic Stewardship Leaders: Carissa Affeldt, Infection Preventionist and Tricia Hove, Director of Nursing
• Highlighted Antibiotic Stewardship Action: SBAR forms are used to standardize communication with providers when nursing staff are concerned about potential infection. Completed SBAR forms are kept as part of the resident’s medical chart. Use of the form by nursing staff has become standard practice.
• Highlighted Collaborative Activity: McIntosh Senior Living participates in the AHRQ Safety Program for Improving Antibiotic Use. They share data for benchmarking, or comparison of practices with those of similar facilities across the country. Comparisons include antibiotic days of therapy, antibiotic starts, C. difficile, and urine culture events.

Renville Health Services

• Antibiotic Stewardship Leaders: Kayla Fitzner, RN, Infection Preventionist and Shannon Hanson, Director of Nursing
• Highlighted Antibiotic Stewardship Action: Renville Health Services participated in the November 2018 Antibiotic Awareness Week with daily Facebook postings about antibiotic use, use of crossword puzzle and word-find activities, and incorporation of additional stewardship tidbits into daily huddles.
• Highlighted Collaborative Activity: Renville Health Services collaborates with Renville County Hospital and Clinics and surrounding nursing homes to advance antibiotic stewardship during care transitions. Collaboration has focused on common strategies to decrease misdiagnosis of urinary tract infections, expanded education on asymptomatic bacteriuria for prescribers and residents/families, and amendment of protocols within the ER to eliminate unnecessary testing, including UA/UC.

Rice Care Center

• Antibiotic Stewardship Leaders: Kenneth M. Flowe, MD; Amanda Thorson, MSN, RN; and Christina Jurgenson, RN
• Highlighted Antibiotic Stewardship Action: Licensed staff use an interactive tool to determine if clinical criteria for infection are met, and if the prescriber needs to be contacted.
• Highlighted Collaborative Activity: Rice Care Center initiated a collaboration with Rice Memorial Hospital to reduce inappropriate testing for Clostridium difficile. The initiative has led to improvements in laboratory and clinical practices. Rice Care Center has also provided education on antibiotic use and resistance to over 700 community members through print materials, in-person education, and discussion opportunities.

Walker Methodist Health Center

• Antibiotic Stewardship Leaders: Janet Gonnella, RN; Brianne Prew, RN; and Neal Buddensiek, MD
• Highlighted Antibiotic Stewardship Action: Walker Methodist Health Center works with their laboratory vendor to obtain a facility antibiogram for E. coli. The antibiogram has been used to develop an Empiric Antibiotic Therapy Recommendations for UTI Treatment document for providers. The document has been highlighted in an antibiotic stewardship educational video and by direct email to providers.
• Highlighted Collaborative Activity: Walker Methodist formed an Antibiotic Stewardship Team intentionally committed to working collaboratively with other stakeholders and groups. The Team includes members from the University of Minnesota, Minnesota Department of Health, and StratisHealth. Team members have shared successes and ongoing challenges with a broader audience at the 2017 MN Collaborative Healthcare-Associated Infections Network and at quarterly meetings of the Metro Alliance of Geriatric Providers.

West Wind Village

• Antibiotic Stewardship Leaders: Shawn Kidd, RN-IPCO and Jody Cunningham, RN
• Highlighted Antibiotic Stewardship Action: A risk benefit form, completed and signed by the prescriber, is signed by the resident or family representative for any prophylactic or long-term use of an antibiotic. The information is reviewed with the resident at every care conference, which has resulted in the discontinuation of some prophylactic antibiotic courses.
• Highlighted Collaborative Activity: West Wind Village collaborates with two local medical centers. They have regularly scheduled meetings to discuss antibiotic stewardship strategies and goals. West Wind Village shares team protocols and pertinent antibiotic use documents such as the minimum criteria for initiating antibiotics. One collaborative meeting discussion led to a new protocol that requires nurse-to-nurse communication whenever a resident is sent to the emergency department or urgent care clinic. The nurse communication includes review of UTI symptoms. This new step has dramatically reduced unnecessary prescribing of antibiotics for UTIs. More broadly, as a result of working together across facilities, providers at both medical centers are quick to respond, problem solve, and put systems in place to address concerns about antibiotic use. 

Current Minnesota Antibiotic Stewardship Long-term Care Silver Level Honor Roll Honorees

Farmington Health Services dba Trinity Care Center

• Antibiotic Stewardship Leaders: Sandra Turbes, Medical Director and Mohamed Ali Bel Fadel, RN-PHN, Infection Prevention and Control
• Highlighted Antibiotic Stewardship Action: Trinity Care Center uses “Do You Need Antibiotics” pamphlets and “Immunity Community” booklets in admissions packets. The pamphlet covers the importance of proper antibiotic use and C. difficile infection as a serious risk associated with antibiotic use. These resources are reviewed with new residents and their families, and staff are available to field questions as needed.

Grand Village

• Antibiotic Stewardship Leaders: Rachel Unger, Infection Preventionist and Holly Moore, Director of Nursing
• Highlighted Antibiotic Stewardship Action: Grand Village developed an information packet using information provided by the CDC on a variety of health care conditions such as C. diff, Vancomycin-Resistant Enterococci (VRE), MRSA, Shingles, and influenza that is provided to families and residents upon admission.

Koochiching Health Services Littlefork Care Center

• Antibiotic Stewardship Leaders: Jessica Carlson and Christine Hagen
• Highlighted Antibiotic Stewardship Action: Littlefork Care Center performs Clostridium difficile tracking and reports data to the Centers for Disease Control and Prevention’s National Healthcare Surveillance Network.

Providence Place

• Antibiotic Stewardship Leaders: Wendy Miron, Infection Preventionist and Darci Fiala, Director of Nursing
• Highlighted Antibiotic Stewardship Action: Nursing staff at Providence Place document all resident condition changes, infection symptoms, and antibiotic use in an electronic tracking tool, which is reviewed daily. Infections and antibiotic use are assessed to determine whether they meet diagnostic and antibiotic initiation criteria, and nursing staff review with providers. Tracked data are compiled monthly for trends and reviewed with an interdisciplinary team at monthly quality meetings.

St. Clare Living Community of Mora

• Antibiotic Stewardship Leaders: Holly Jablonski, RN, BSN, Infection Preventionist and April Leverty, RN, DON
• Highlighted Antibiotic Stewardship Action: Routine antibiotic time-out is conducted within 72 hours of initial antibiotic dose, and regular review of antibiotic use data is conducted with a pharmacist.

Current Minnesota Antibiotic Stewardship Long-term Care Bronze Level Honor Roll Honorees

Mille Lacs Health System

• Antibiotic Stewardship Leaders: Vicki Engmark, Infection Preventionist and Cynthia Sutherland, Director of Nursing