Minnesota Antimicrobial Stewardship Program Toolkit for Long-term Care Facilities

Overview

Antimicrobial stewardship programs facilitate the responsible use and protection of all antimicrobials and in turn, improve patient safety, reduce health care costs and potentially impact rates of antimicrobial resistance.

This toolkit was developed in collaboration with several long-term care facility partners to offer concrete tools that could help facilities recognize their baseline antimicrobial stewardship capacity and enhance their existing assessment, documentation, and communication processes.  It is organized in a series of appendices.

• Cover (PDF)
• Introduction (PDF)
• Acknowledgements (PDF)
• Appendix A: Long-Term Care Facility Capacity to Implement an Antimicrobial Stewardship Program- A Conceptual Model
  (PDF)

Core Tools, Baseline Assessments

Begin by using the core tools to assess existing processes for opportunities to incorporate antimicrobial stewardship.
The core tools include: Action steps and strategies for implementing antimicrobial stewardship, an antimicrobial stewardship gap analysis, nursing staff and provider antibiotic use attitudes and beliefs surveys, an antimicrobial use assessment tool, and a nursing process evaluation tool.

• Appendix B: Action Steps and Strategies for Implementing Antimicrobial Stewardship in Long-term Care Facilities
  (PDF) | (Word)
• Appendix C: Antimicrobial Stewardship Gap Analysis Tool
  (PDF) | (Word)
• Appendix D: Nursing and Provider Antibiotic Use Attitudes and Beliefs Surveys
  (PDF) | (Word)
• Appendix E: Antimicrobial Use Assessment for Long-term Care Facilities
  (PDF) | (Word)
• Appendix F: Nursing Process Evaluation Tool – Resident Change in Condition
  (PDF) | (Word)

Supplemental Tools

Next, apply the information from the baseline assessments by incorporating the appropriate supplemental tools into the facility workflow.
Supplemental tools include: nursing communication tools, infection surveillance tools, and clinical decision-making tools  

Nursing Communication Tools:

• Appendix G: SBAR: Situation, Background, Assessment, Request
  (PDF) | (Word)
• Appendix H: Concerned- Uncomfortable- Safety (CUS) Communication Tool
  (PDF) | (Word)
• Appendix I: Changes That Matter Tool
  (PDF) | (Word)

Infection Surveillance Tools:

• Appendix J: Tips for Applying CDC’s Infection Surveillance Guidance in Long-term Care Facilities
  (PDF) | (Word)
• Appendix K: Infection Surveillance Definition Worksheet
  (PDF) | (Word)
• Appendix L: Infection and Antibiotic Use Tracking Tool
  Instructions (PDF) | (Excel)
  updated 11/2018
  • WebEx Recording: Infection and Antibiotic Use Tracking in Long-term Care (1 hour)
    Recorded on Feb. 15, 2019
    Evaluation and CEU

Clinical Decision-Making Tools:

• Appendix M: Prevention and Management of Clostridium difficile Infections in Long-term Care (PDF)
• Appendix N: Minimum Criteria for Initiation of Antibiotics in Long-Term Care Residents
• Loeb and McGeer Criteria: A Practical Guide for Use in Long-term Care (PDF)

Templates and Sample Letters

• 72-Hour Antibiotic Time-Out Sample Template (PDF) | (Word)
• Template Feedback Form for Providers: Long-term Care Prescribing
  (PDF) | (Word)
• Sample Letter to Providers: Communicate Antibiotic Stewardship Priorities
  (PDF) | (Word)
• Sample Letter to Obtain an Antibiogram from a Laboratory (PDF) | (Word)
• Sample Newsletter Article for Long-term Care Facilities (PDF) | (Word)

Additional Materials

Finally, use these additional resources to provide education based on lessons learned from baseline assessments and implementation of supplemental tools.
Additional resources include: educational modules, fact sheets, and helpful references.

Education Modules for Nurses and Nursing Assistants

Antibiotic Use &  Antibiotic Resistance

• Educational Module for Nurses in Long-term Care Facilities: Antibiotic Use &  Antibiotic Resistance (PDF)
  • Slides (PDF)
  • Post-Test Questions (PDF)
• Educational Module for Nursing Assistants in Long-term Care Facilities: Antibiotic Use &  Antibiotic Resistance (PDF: 428KB/21 pages)
  • Slides (PDF)
  • Post-Test Questions (PDF)

Clostridium difficile Infection Prevention

• Educational Module for Nurses in Long-term Care Facilities: Preventing and Managing Clostridium difficile Infections (PDF)
  • Slides (PDF)
  • Post-Test Questions (PDF)
• Educational Module for Nursing Assistants in Long-term Care Facilities: Preventing and Managing Clostridium difficile Infections (PDF)
  • Slides (PDF)
  • Post-Test Questions (PDF)

Urinary Tract Infections and Asymptomatic Bacteriuria

• Educational Module for Nurses in Long-term Care Facilities: Urinary Tract Infections & Asymptomatic Bacteriuria (PDF)
  • Slides (PDF)
  • Post-Test Questions (PDF)
• Educational Module for Nursing Assistants in Long-term Care Facilities: Urinary Tract Infections &Asymptomatic Bacteriuria (PDF)
  • Slides (PDF)
  • Post-Test Questions (PDF)

Nursing Skills Fair Questions

• Skills Fair Game Questions for Licensed Nurses (PDF)
• Nursing Skills Fair Game Questions for Unlicensed Nursing Staff (PDF)

Antimicrobial Stewardship Presentations

• Antimicrobial Stewardship and Long-Term Care (PDF)
  Background on Antimicrobial Stewardship for Providers
• Keep Antibiotics Working For Residents in Long-Term Care Facilities (PDF)
  Background on Antimicrobial Stewardship for Nurses

Flyers, Table Tents, and Quizzes

Antibiotic Use & Antibiotic Resistance

• Cover: Help Prevent Antibiotic Resistance (PDF)
• Flyer: What’s Your “Antibiotic IQ”? Quiz (PDF)
• Table Tent: What’s Your “Antibiotic IQ”? Quiz (PDF)
• Slides: What’s Your “Antibiotic IQ”? Quiz (PDF)

Clostridium difficile Infection Prevention

• Cover: Prevent Clostridium difficile! (PDF)
• Flyer: Preventing Clostridium difficile in Long-term Care (PDF)
• Table Tent: Preventing Clostridium difficile in Long-term Care (PDF)
• Slides: Understanding and Preventing Clostridium difficile (PDF)

Urinary Tract Infections and Asymptomatic Bacteriuria

• Cover: Get the Catheters Out! (PDF)
• Flyer: Urinary Tract Infections in Long-term Care Residents (PDF)
• Table Tent: Urinary Tract Infections in Long-term Care Residents (PDF)
• Slides: Urinary Tract Infections in Long-term Care Residents (PDF)

Hand Hygiene

• Cover: Practice Good Hand Hygiene to Help Prevent the Spread of Germs (PDF)
• Flyer: Hand Hygiene Quick Quiz (PDF)
• Table Tent: Hand Hygiene Quick Quiz (PDF)
• Slides: Hand Hygiene Facts and Quiz (PDF)

Fact Sheets and Guidelines

• About Antibiograms (PDF)
• Antimicrobial Stewardship in Long-Term Care (PDF)
• Asymptomatic Bacteriuria in Long-Term Care (PDF)
• Guideline for the Management of Antimicrobial Resistant Microorganisms in Minnesota Long-Term Care Facilities
  
• CDC: Core Elements of Antibiotic Stewardship for Nursing Homes