Abstract
BackgroundIn 2017, the Centers for Medicare and Medicaid Services required all long-term care facilities, including nursing homes, to have an antibiotic stewardship program. Many nursing homes lack the resources, expertise, or infrastructure to track and analyze antibiotic use measures. Here, we demonstrate that pharmacy invoices are a viable source of data to track and report antibiotic use in nursing homes.MethodsThe dispensing pharmacy working with several nursing homes in the same healthcare corporation provided pharmacy invoices from 2014 to 2016 as files formatted as comma separated values. We aggregated these files by aligning elements into a consistent set of variables and assessed the completeness of data from each nursing home over time. Data cleaning involved removing rows that did not describe systemic medications, de-duplication, consolidating prescription refills, and removing prescriptions for insulin and opioids, which are medications that were not administered at a regular dose or schedule. After merging this cleaned invoice data to nursing home census data including bed days of care and publicly available data characterizing bed allocation for each nursing home, we used the resulting database to describe several antibiotic use metrics and generated an interactive website to permit further analysis.ResultsThe resultant database permitted assessment of the following antibiotic use metrics: days of antibiotic therapy, length of antibiotic therapy, rate of antibiotic starts, and the antibiotic spectrum index. Further, we created a template for summarizing data within a facility and comparing across facilities. https://sunahsong.shinyapps.io/USNursingHomes/.ConclusionsLack of resources and infrastructure contributes to challenges facing nursing homes as they develop antibiotic stewardship programs. Our experience with using pharmacy invoice data may serve as a useful approach for nursing homes to track and report antibiotic use.
Highlights
In 2017, the Centers for Medicare and Medicaid Services required all long-term care facilities, including nursing homes, to have an antibiotic stewardship program
We describe in detail the process of transforming pharmacy invoices into a robust dataset that permits assessment of the following important antibiotic use metrics: overall days of therapy; length of therapy; antibiotic starts; use of intravenous agents; spectrum of antibiotic use based on specific antibiotic classes
We assigned ‘SleepyHollow’ as a facility name for rows that contained ‘SleepyHollow’, ‘Sleepy Hollow’, or ‘Sleep Hollow Continuing care retirement community (CCRC)’; CCRC is an acronym for continuing care retirement community
Summary
In 2017, the Centers for Medicare and Medicaid Services required all long-term care facilities, including nursing homes, to have an antibiotic stewardship program. Driven by the increasing prevalence of both CDI and MDROs across all healthcare settings [11, 12], the Centers for Medicare and Medicaid Services (CMS) required all nursing homes to have an antibiotic stewardship program by November 2017 [13]. In support of these efforts, the Centers of Disease Control and Prevention (CDC) developed a framework for antibiotic stewardship implementation called the Core Elements that detail actions critical for the success of antibiotic stewardship implementation [14]. We developed a web interface that supports further analysis as well as tracking and reporting antibiotic use
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
