Robin Jump - Academia.edu (original) (raw)
Papers by Robin Jump
American journal of infection control, Jan 8, 2017
To support the role of nurses as active proponents of antimicrobial stewardship in long-term care... more To support the role of nurses as active proponents of antimicrobial stewardship in long-term care facilities, we developed an educational intervention consisting of a free online course comprised of 6 interactive modules. Here, we report the effect of the course on the knowledge, beliefs, and attitudes toward antimicrobial stewardship of nurses working in long-term care facilities. We used a paired pre- and postcourse survey instrument to assess nurses' knowledge regarding the care of long-term care facility residents with infections and attitudes and beliefs regarding antimicrobial stewardship. There were 103 respondents, registered nurses or licensed practical nurses, who completed the pre- and postsurveys. Their mean knowledge scores improved from 75% (precourse) to 86% (postcourse, P <.001). After the course, nurses' agreement that their role influences whether residents receive antimicrobials increased significantly (P <.001). The online course improves nurses'...
Open Forum Infectious Diseases, 2017
P = 0.02). No significant changes in mortality, length of stay, and 30-day readmission rates were... more P = 0.02). No significant changes in mortality, length of stay, and 30-day readmission rates were observed for either group. Conclusion. ASP rounds identified ample opportunities for improvement in ABX utilization in both NTH and TS models. Rounds were associated with a significant reduction in anti-PSA DOT for both models and a significant reduction in overall ABX DOT for NTH group. Although NTH provided a higher patient volume and allowed for more interventions per ASP-hour compared with the TS model, acceptance rates were lower, which may reflect a shorter amount of time spent on patient discussions. Disclosures. All authors: No reported disclosures.
Open Forum Infectious Diseases, 2020
Background An estimated 30% of antibiotic prescriptions in outpatient settings may be inappropria... more Background An estimated 30% of antibiotic prescriptions in outpatient settings may be inappropriate. Antibiotic exposure increases an individual’s risk of Clostridioides difficile infection (CDI) and acquiring drug-resistant pathogens. To quantify the increased risk of CDI and drug-resistant pathogens posed by antibiotics prescribed in outpatient visits, we examined a two-year cohort of patients seen in primary care clinics at VA Community-Based Outpatient Clinics (CBOC) associated with a large VA Medical Center. Methods Among patients with an in-person visit at 13 CBOCs in 2018–2019, we examined rates of antibiotic-associated adverse events (AEs), defined as community-onset CDI or acquisition of resistant Gram-negative bacteria (R-GNB), in the 90 days following those visits. For each visit, we used administrative databases to determine if systemic antibiotics were prescribed, if there was an associated infectious diagnosis, and the subsequent occurrence of AEs. We summarized quarte...
Open Forum Infectious Diseases, 2020
Background Implementing effective antibiotic stewardship programs (ASPs) in long-term care (LTC) ... more Background Implementing effective antibiotic stewardship programs (ASPs) in long-term care (LTC) settings is challenging. We present the results of an intervention intended to change the culture of antibiotic prescribing in 439 United States LTC facilities (LTCF). Methods The LTC Safety Program assisted LTCFs with establishing and implementing ASPs from 12/2018 to 11/2019. Through webinars held 1–2 times per month and other educational content, the Safety Program emphasized 1) the science of safety to improve teamwork and identify antibiotic-associated harm and 2) clinical best practices in making antibiotic treatment decisions. Content was organized using the Four Moments of Antibiotic Decision Making Framework (Figure 1). All staff (e.g., physicians, nurses, nurse assistants) were encouraged to participate. LTCFs submitted monthly antibiotic days of therapy (DOT), numbers of new antibiotic starts, urine cultures (UCX) ordered, Clostridioides difficile LabID events, and census data...
MedEdPORTAL, 2018
Introduction: Compared with younger populations, adults 65 years and older are more likely to suf... more Introduction: Compared with younger populations, adults 65 years and older are more likely to suffer infection-related morbidity and mortality, experience antibiotic-related adverse events, and acquire multidrug-resistant organisms. We developed a series of case-based discussions that stressed antibiotic stewardship while addressing management of common infections in older adults. Methods: Five 1-hour case-based discussions address recognition, diagnosis, and management of infections common in older adults, including those living in long-term care settings: urinary tract infections, upper respiratory tract infections, lower respiratory tract infections, skin and soft tissue infections, and Clostridium difficile infection. The education was implemented at the skilled nursing centers at 15 Veterans Affairs medical centers. Participants from an array of disciplines completed an educational evaluation for each session as well as a pre-and postcourse knowledge assessment. Results: The number of respondents to the educational evaluation administered following each session ranged from 68 to 108. Learners agreed that each session met its learning objectives (4.80-4.89 on a 5-point Likert scale, 5 = strongly agree) and that they were likely to make changes (2.50-2.89 on a 3-point scale, 3 = highly likely to make changes). The average score on the five-question knowledge assessment increased from 3.6 (72%) to 3.9 (78%, p = .06). Discussion: By stressing recognition of atypical signs and symptoms of infection in older adults, diagnostic tests, and antibiotic stewardship, this series of five case-based discussions enhanced clinical training of learners from several disciplines.
Open Forum Infectious Diseases, 2018
Background Long-term care facilities (LTCFs) face several barriers to creating antibiograms. Here... more Background Long-term care facilities (LTCFs) face several barriers to creating antibiograms. Here, we evaluate if LTCFs can use antibiograms from affiliated hospitals as their own antibiogram. Methods Facility-specific antibiograms were created for all Veterans Affairs (VA) LTCFs and VA Medical Centers (VAMCs) for 2017. LTCFs and affiliated VAMCs were paired and classified as being on the same campus or geographically distinct campuses based on self-report. For each pair, Escherichia coli susceptibility rates (%S) to cefazolin, ceftriaxone, cefepime, ciprofloxacin, nitrofurantoin, sulfamethoxazole/trimethoprim, ampicillin/sulbactam, piperacillin/tazobactam, and imipenem were compared. As guidelines discourage empiric use of antibiotics if susceptibility rates are <80%, we assessed clinical discordance between each LTCF and affiliated VAMC antibiogram at a threshold of 80% susceptible. The proportions of concordant susceptibilities between LTCFs and VAMCs on the same campus vs. ge...
Open Forum Infectious Diseases, 2018
Background Telehealth offers the possibility of supporting antibiotic stewardship in settings wit... more Background Telehealth offers the possibility of supporting antibiotic stewardship in settings with limited access to people with infectious diseases (ID) expertise. Previously, we described preliminary results from a pilot project that used the Veterans Affairs (VA) telehealth system to facilitate a Videoconference Antimicrobial Stewardship Team (VAST) which connected a multidisciplinary team from a rural VA medical center (VAMC) with ID physicians at a remote site to support antibiotic stewardship. Here, we present 3 distinct metrics to assess the influence of the VAST on antibiotic use at 2 intervention sites. Methods Outcomes assessed antibiotic use in the hospital and long-term care units of 2 rural VAMCs in the year before and after VAST implementation, allowing for a 1-month wash-in period in the first month of the VAST. Using VA databases, we determined 3 metrics: the rate of antibiotic use (days of therapy per 1,000 bed days of care); the mean length of therapy (days); and t...
Clinical Infectious Diseases, 2017
Implementing effective antimicrobial stewardship in long-term care facilities (LTCFs) is associat... more Implementing effective antimicrobial stewardship in long-term care facilities (LTCFs) is associated with challenges distinct from those faced by hospitals. LTCFs generally care for elderly populations who are vulnerable to infection, have prescribers who are often off-site, and have limited access to timely diagnostic testing. Identification of feasible interventions in LTCFs is important, particularly given the new requirement for stewardship programs by the Centers for Medicare and Medicaid Services (CMS). In this integrative review, we analyzed published evidence in the context of a human factors engineering approach as well as educational interventions to understand aspects of multimodal interventions associated with the implementation of successful stewardship programs in LTCFs. The outcomes indicate that effective antimicrobial stewardship in long-term care is supported by incorporating multidisciplinary education, tools integrated into the workflow of nurses and prescribers that facilitate review of antibiotic use, and involvement of infectious disease consultants. Keywords. antimicrobial stewardship; nursing home; long-term care; human factors; elderly. METHODS Using integrative review methodology [9], we searched PubMed for peer-reviewed medical literature describing antimicrobial stewardship interventions in LTCFs. Iterative searching of
Journal of the American Medical Directors Association, Jan 18, 2017
In response to a rising concern for multidrug resistance and Clostridium difficile infections, th... more In response to a rising concern for multidrug resistance and Clostridium difficile infections, the Centers for Medicare and Medicaid services (CMS) will require all long-term care (LTC) facilities to establish an antibiotic stewardship program by November 2017. Thus far, limited evidence describes implementation of antibiotic stewardship in LTC facilities, mostly in academic- or hospital-affiliated settings. To support compliance with CMS requirements and aid facilities in establishing a stewardship program, the Infection Advisory Committee at AMDA-The Society for Post-Acute and Long-Term Care Medicine, has developed an antibiotic stewardship policy template tailored to the LTC setting. The intent of this policy, which can be adapted by individual facilities, is to help LTC facilities implement an antibiotic stewardship policy that will meet or exceed CMS requirements. We also briefly discuss implementation of an antibiotic stewardship program in LTC settings, including a list of fr...
Open Forum Infectious Diseases, 2016
American Journal of Infection Control, 2016
We describe a course in the Veterans Affairs (VA) Employee Education System designed to engage nu... more We describe a course in the Veterans Affairs (VA) Employee Education System designed to engage nursing staff working in VA long-term care facilities as partners in antimicrobial stewardship. We found that the course addressed an important knowledge gap. Our outcomes suggest opportunities to engage nursing staff in advancing antimicrobial stewardship, particularly in the long-term care setting. Published by Elsevier Inc. on behalf of the Association for Professionals in Infection Control and Epidemiology, Inc.
American Journal of Infection Control, 2015
We conducted an anonymous survey of providers who care for older adults from 10 Veterans Affairs ... more We conducted an anonymous survey of providers who care for older adults from 10 Veterans Affairs long-term-care facilities to assess their knowledge, beliefs, and confidence toward treating infections and antimicrobial stewardship. The average score on 5 questions assessing knowledge was 3.6 out of 5.0 (95% confidence interval, 3.3-3.9), which supports a need for education regarding the care of older adults with infections. Published by Elsevier Inc. on behalf of the Association for Professionals in Infection Control and Epidemiology, Inc.
Journal of the American Geriatrics Society, 2013
BACKGROUND/OBJECTIVE-Antimicrobials are frequently prescribed in long-term care facilities (LTCFs... more BACKGROUND/OBJECTIVE-Antimicrobials are frequently prescribed in long-term care facilities (LTCFs). In order to develop effective stewardship interventions, there is a need for data on current patterns of unnecessary antimicrobial prescribing among LTCF residents. The objective of this study was to examine the frequency of, reasons for, and adverse effects of unnecessary antimicrobial use in our Veterans Affairs (VA) LTCF. DESIGN-Retrospective chart review. SETTING-Cleveland VA Medical Center LTCF.
Journal of the American Geriatrics Society, 2013
Background-Residents of long-term care facilities (LTCFs) are a population vulnerable to infectio... more Background-Residents of long-term care facilities (LTCFs) are a population vulnerable to infections and to the adverse effects of inappropriate antimicrobial prescribing. To improve the care of residents with possible infections, we initiated a LTCF Infectious Disease (LID) service that provides on-site consultations to LTCF residents. Design-Clinical demonstration project Setting-A 160-bed LTCF affiliated with a tertiary care Veterans Affairs (VA) hospital. Participants-Residents referred to the LID Team.
Infection Control & Hospital Epidemiology, 2012
Design.We introduced a long-term care facility (LTCF) infectious disease (ID) consultation servic... more Design.We introduced a long-term care facility (LTCF) infectious disease (ID) consultation service (LID service) that provides on-site consultations to residents of a Veterans Affairs (VA) LTCF. We determined the impact of the LID service on antimicrobial use and Clostridium difficile infections at the LTCF.Setting.A 160-bed VA LTCF.Methods.Systemic antimicrobial use and positive C. difficile tests at the LTCF were compared for the 36 months before and the 18 months after the initiation of the ID consultation service through segmented regression analysis of an interrupted time series.Results.Relative to that in the preintervention period, total systemic antibiotic administration decreased by 30% (P<.001), with significant reductions in both oral (32%; P<.001) and intravenous (25%; P = .008) agents. The greatest reductions were seen for tetracyclines (64%; P<.001), clindamycin (61%; P<.001), sulfamethoxazole/trimethoprim (38%; P<.001), fluoroquinolones (38%; P<.001)...
Infection Control & Hospital Epidemiology, 2011
In a Veterans Affairs medical center, 39% of healthcare facility–onset, healthcare facility-assoc... more In a Veterans Affairs medical center, 39% of healthcare facility–onset, healthcare facility-associated Clostridium difficile infections had their onset in the affiliated long-term care facility (LTCF). Eighty-five percent of LTCF-onset patients had been transferred from the hospital within the past month. Delays in diagnosis and treatment were common for LTCF-onset patients.
Emerging Infectious Diseases, 2010
Clinical Infectious Diseases, 2007
Journal of the American Medical Directors Association, 2015
Care and that they were participating more at the home level with the management team, committee ... more Care and that they were participating more at the home level with the management team, committee involvement, compliance reviews and review of policies and procedures. Other areas of improvement were with respect to medical staff management, organizing the medical staff, implementing quality improvement projects such as safe prescribing, improvements in quarterly medication reviews, reduction in antipsychotic use, pain management, Emergency Department utilization, after hours care, updating clinical templates for physical examinations. The evaluations from the inaugural training were overall very positive particularly with respect to the small group cases and relevance to their practice. The LTC Sector has also been very positive in response to the training to the extent that we have now received a grant to further develop and enhance the program as it moves forward. Conclusion: The OLTCP has successfully developed and implemented a new Medical Director Training for Ontario, Canada. The response from attendees, the general membership and the LTC Sector have endorsed that this was a much needed resource for Medical Directors in our province. We plan to offer the training on an annual basis. New funding will support the development of a more sophisticated e-learning component for the pre-course work with opportunities over time to build continued learning opportunities to further support peer to peer networking and capacity building.We believe that there is opportunity for this education program to be considered as International Equivalency to the ADMA Core Curriculume supporting peer to peer networking both on a National and International stage. This has the potential to further extend the reach of AMDA. Author Disclosures: All authors have stated there are no financial disclosures to be made that are pertinent to this abstract.
Journal of the American Geriatrics Society, 2013
American journal of infection control, Jan 8, 2017
To support the role of nurses as active proponents of antimicrobial stewardship in long-term care... more To support the role of nurses as active proponents of antimicrobial stewardship in long-term care facilities, we developed an educational intervention consisting of a free online course comprised of 6 interactive modules. Here, we report the effect of the course on the knowledge, beliefs, and attitudes toward antimicrobial stewardship of nurses working in long-term care facilities. We used a paired pre- and postcourse survey instrument to assess nurses' knowledge regarding the care of long-term care facility residents with infections and attitudes and beliefs regarding antimicrobial stewardship. There were 103 respondents, registered nurses or licensed practical nurses, who completed the pre- and postsurveys. Their mean knowledge scores improved from 75% (precourse) to 86% (postcourse, P <.001). After the course, nurses' agreement that their role influences whether residents receive antimicrobials increased significantly (P <.001). The online course improves nurses'...
Open Forum Infectious Diseases, 2017
P = 0.02). No significant changes in mortality, length of stay, and 30-day readmission rates were... more P = 0.02). No significant changes in mortality, length of stay, and 30-day readmission rates were observed for either group. Conclusion. ASP rounds identified ample opportunities for improvement in ABX utilization in both NTH and TS models. Rounds were associated with a significant reduction in anti-PSA DOT for both models and a significant reduction in overall ABX DOT for NTH group. Although NTH provided a higher patient volume and allowed for more interventions per ASP-hour compared with the TS model, acceptance rates were lower, which may reflect a shorter amount of time spent on patient discussions. Disclosures. All authors: No reported disclosures.
Open Forum Infectious Diseases, 2020
Background An estimated 30% of antibiotic prescriptions in outpatient settings may be inappropria... more Background An estimated 30% of antibiotic prescriptions in outpatient settings may be inappropriate. Antibiotic exposure increases an individual’s risk of Clostridioides difficile infection (CDI) and acquiring drug-resistant pathogens. To quantify the increased risk of CDI and drug-resistant pathogens posed by antibiotics prescribed in outpatient visits, we examined a two-year cohort of patients seen in primary care clinics at VA Community-Based Outpatient Clinics (CBOC) associated with a large VA Medical Center. Methods Among patients with an in-person visit at 13 CBOCs in 2018–2019, we examined rates of antibiotic-associated adverse events (AEs), defined as community-onset CDI or acquisition of resistant Gram-negative bacteria (R-GNB), in the 90 days following those visits. For each visit, we used administrative databases to determine if systemic antibiotics were prescribed, if there was an associated infectious diagnosis, and the subsequent occurrence of AEs. We summarized quarte...
Open Forum Infectious Diseases, 2020
Background Implementing effective antibiotic stewardship programs (ASPs) in long-term care (LTC) ... more Background Implementing effective antibiotic stewardship programs (ASPs) in long-term care (LTC) settings is challenging. We present the results of an intervention intended to change the culture of antibiotic prescribing in 439 United States LTC facilities (LTCF). Methods The LTC Safety Program assisted LTCFs with establishing and implementing ASPs from 12/2018 to 11/2019. Through webinars held 1–2 times per month and other educational content, the Safety Program emphasized 1) the science of safety to improve teamwork and identify antibiotic-associated harm and 2) clinical best practices in making antibiotic treatment decisions. Content was organized using the Four Moments of Antibiotic Decision Making Framework (Figure 1). All staff (e.g., physicians, nurses, nurse assistants) were encouraged to participate. LTCFs submitted monthly antibiotic days of therapy (DOT), numbers of new antibiotic starts, urine cultures (UCX) ordered, Clostridioides difficile LabID events, and census data...
MedEdPORTAL, 2018
Introduction: Compared with younger populations, adults 65 years and older are more likely to suf... more Introduction: Compared with younger populations, adults 65 years and older are more likely to suffer infection-related morbidity and mortality, experience antibiotic-related adverse events, and acquire multidrug-resistant organisms. We developed a series of case-based discussions that stressed antibiotic stewardship while addressing management of common infections in older adults. Methods: Five 1-hour case-based discussions address recognition, diagnosis, and management of infections common in older adults, including those living in long-term care settings: urinary tract infections, upper respiratory tract infections, lower respiratory tract infections, skin and soft tissue infections, and Clostridium difficile infection. The education was implemented at the skilled nursing centers at 15 Veterans Affairs medical centers. Participants from an array of disciplines completed an educational evaluation for each session as well as a pre-and postcourse knowledge assessment. Results: The number of respondents to the educational evaluation administered following each session ranged from 68 to 108. Learners agreed that each session met its learning objectives (4.80-4.89 on a 5-point Likert scale, 5 = strongly agree) and that they were likely to make changes (2.50-2.89 on a 3-point scale, 3 = highly likely to make changes). The average score on the five-question knowledge assessment increased from 3.6 (72%) to 3.9 (78%, p = .06). Discussion: By stressing recognition of atypical signs and symptoms of infection in older adults, diagnostic tests, and antibiotic stewardship, this series of five case-based discussions enhanced clinical training of learners from several disciplines.
Open Forum Infectious Diseases, 2018
Background Long-term care facilities (LTCFs) face several barriers to creating antibiograms. Here... more Background Long-term care facilities (LTCFs) face several barriers to creating antibiograms. Here, we evaluate if LTCFs can use antibiograms from affiliated hospitals as their own antibiogram. Methods Facility-specific antibiograms were created for all Veterans Affairs (VA) LTCFs and VA Medical Centers (VAMCs) for 2017. LTCFs and affiliated VAMCs were paired and classified as being on the same campus or geographically distinct campuses based on self-report. For each pair, Escherichia coli susceptibility rates (%S) to cefazolin, ceftriaxone, cefepime, ciprofloxacin, nitrofurantoin, sulfamethoxazole/trimethoprim, ampicillin/sulbactam, piperacillin/tazobactam, and imipenem were compared. As guidelines discourage empiric use of antibiotics if susceptibility rates are <80%, we assessed clinical discordance between each LTCF and affiliated VAMC antibiogram at a threshold of 80% susceptible. The proportions of concordant susceptibilities between LTCFs and VAMCs on the same campus vs. ge...
Open Forum Infectious Diseases, 2018
Background Telehealth offers the possibility of supporting antibiotic stewardship in settings wit... more Background Telehealth offers the possibility of supporting antibiotic stewardship in settings with limited access to people with infectious diseases (ID) expertise. Previously, we described preliminary results from a pilot project that used the Veterans Affairs (VA) telehealth system to facilitate a Videoconference Antimicrobial Stewardship Team (VAST) which connected a multidisciplinary team from a rural VA medical center (VAMC) with ID physicians at a remote site to support antibiotic stewardship. Here, we present 3 distinct metrics to assess the influence of the VAST on antibiotic use at 2 intervention sites. Methods Outcomes assessed antibiotic use in the hospital and long-term care units of 2 rural VAMCs in the year before and after VAST implementation, allowing for a 1-month wash-in period in the first month of the VAST. Using VA databases, we determined 3 metrics: the rate of antibiotic use (days of therapy per 1,000 bed days of care); the mean length of therapy (days); and t...
Clinical Infectious Diseases, 2017
Implementing effective antimicrobial stewardship in long-term care facilities (LTCFs) is associat... more Implementing effective antimicrobial stewardship in long-term care facilities (LTCFs) is associated with challenges distinct from those faced by hospitals. LTCFs generally care for elderly populations who are vulnerable to infection, have prescribers who are often off-site, and have limited access to timely diagnostic testing. Identification of feasible interventions in LTCFs is important, particularly given the new requirement for stewardship programs by the Centers for Medicare and Medicaid Services (CMS). In this integrative review, we analyzed published evidence in the context of a human factors engineering approach as well as educational interventions to understand aspects of multimodal interventions associated with the implementation of successful stewardship programs in LTCFs. The outcomes indicate that effective antimicrobial stewardship in long-term care is supported by incorporating multidisciplinary education, tools integrated into the workflow of nurses and prescribers that facilitate review of antibiotic use, and involvement of infectious disease consultants. Keywords. antimicrobial stewardship; nursing home; long-term care; human factors; elderly. METHODS Using integrative review methodology [9], we searched PubMed for peer-reviewed medical literature describing antimicrobial stewardship interventions in LTCFs. Iterative searching of
Journal of the American Medical Directors Association, Jan 18, 2017
In response to a rising concern for multidrug resistance and Clostridium difficile infections, th... more In response to a rising concern for multidrug resistance and Clostridium difficile infections, the Centers for Medicare and Medicaid services (CMS) will require all long-term care (LTC) facilities to establish an antibiotic stewardship program by November 2017. Thus far, limited evidence describes implementation of antibiotic stewardship in LTC facilities, mostly in academic- or hospital-affiliated settings. To support compliance with CMS requirements and aid facilities in establishing a stewardship program, the Infection Advisory Committee at AMDA-The Society for Post-Acute and Long-Term Care Medicine, has developed an antibiotic stewardship policy template tailored to the LTC setting. The intent of this policy, which can be adapted by individual facilities, is to help LTC facilities implement an antibiotic stewardship policy that will meet or exceed CMS requirements. We also briefly discuss implementation of an antibiotic stewardship program in LTC settings, including a list of fr...
Open Forum Infectious Diseases, 2016
American Journal of Infection Control, 2016
We describe a course in the Veterans Affairs (VA) Employee Education System designed to engage nu... more We describe a course in the Veterans Affairs (VA) Employee Education System designed to engage nursing staff working in VA long-term care facilities as partners in antimicrobial stewardship. We found that the course addressed an important knowledge gap. Our outcomes suggest opportunities to engage nursing staff in advancing antimicrobial stewardship, particularly in the long-term care setting. Published by Elsevier Inc. on behalf of the Association for Professionals in Infection Control and Epidemiology, Inc.
American Journal of Infection Control, 2015
We conducted an anonymous survey of providers who care for older adults from 10 Veterans Affairs ... more We conducted an anonymous survey of providers who care for older adults from 10 Veterans Affairs long-term-care facilities to assess their knowledge, beliefs, and confidence toward treating infections and antimicrobial stewardship. The average score on 5 questions assessing knowledge was 3.6 out of 5.0 (95% confidence interval, 3.3-3.9), which supports a need for education regarding the care of older adults with infections. Published by Elsevier Inc. on behalf of the Association for Professionals in Infection Control and Epidemiology, Inc.
Journal of the American Geriatrics Society, 2013
BACKGROUND/OBJECTIVE-Antimicrobials are frequently prescribed in long-term care facilities (LTCFs... more BACKGROUND/OBJECTIVE-Antimicrobials are frequently prescribed in long-term care facilities (LTCFs). In order to develop effective stewardship interventions, there is a need for data on current patterns of unnecessary antimicrobial prescribing among LTCF residents. The objective of this study was to examine the frequency of, reasons for, and adverse effects of unnecessary antimicrobial use in our Veterans Affairs (VA) LTCF. DESIGN-Retrospective chart review. SETTING-Cleveland VA Medical Center LTCF.
Journal of the American Geriatrics Society, 2013
Background-Residents of long-term care facilities (LTCFs) are a population vulnerable to infectio... more Background-Residents of long-term care facilities (LTCFs) are a population vulnerable to infections and to the adverse effects of inappropriate antimicrobial prescribing. To improve the care of residents with possible infections, we initiated a LTCF Infectious Disease (LID) service that provides on-site consultations to LTCF residents. Design-Clinical demonstration project Setting-A 160-bed LTCF affiliated with a tertiary care Veterans Affairs (VA) hospital. Participants-Residents referred to the LID Team.
Infection Control & Hospital Epidemiology, 2012
Design.We introduced a long-term care facility (LTCF) infectious disease (ID) consultation servic... more Design.We introduced a long-term care facility (LTCF) infectious disease (ID) consultation service (LID service) that provides on-site consultations to residents of a Veterans Affairs (VA) LTCF. We determined the impact of the LID service on antimicrobial use and Clostridium difficile infections at the LTCF.Setting.A 160-bed VA LTCF.Methods.Systemic antimicrobial use and positive C. difficile tests at the LTCF were compared for the 36 months before and the 18 months after the initiation of the ID consultation service through segmented regression analysis of an interrupted time series.Results.Relative to that in the preintervention period, total systemic antibiotic administration decreased by 30% (P<.001), with significant reductions in both oral (32%; P<.001) and intravenous (25%; P = .008) agents. The greatest reductions were seen for tetracyclines (64%; P<.001), clindamycin (61%; P<.001), sulfamethoxazole/trimethoprim (38%; P<.001), fluoroquinolones (38%; P<.001)...
Infection Control & Hospital Epidemiology, 2011
In a Veterans Affairs medical center, 39% of healthcare facility–onset, healthcare facility-assoc... more In a Veterans Affairs medical center, 39% of healthcare facility–onset, healthcare facility-associated Clostridium difficile infections had their onset in the affiliated long-term care facility (LTCF). Eighty-five percent of LTCF-onset patients had been transferred from the hospital within the past month. Delays in diagnosis and treatment were common for LTCF-onset patients.
Emerging Infectious Diseases, 2010
Clinical Infectious Diseases, 2007
Journal of the American Medical Directors Association, 2015
Care and that they were participating more at the home level with the management team, committee ... more Care and that they were participating more at the home level with the management team, committee involvement, compliance reviews and review of policies and procedures. Other areas of improvement were with respect to medical staff management, organizing the medical staff, implementing quality improvement projects such as safe prescribing, improvements in quarterly medication reviews, reduction in antipsychotic use, pain management, Emergency Department utilization, after hours care, updating clinical templates for physical examinations. The evaluations from the inaugural training were overall very positive particularly with respect to the small group cases and relevance to their practice. The LTC Sector has also been very positive in response to the training to the extent that we have now received a grant to further develop and enhance the program as it moves forward. Conclusion: The OLTCP has successfully developed and implemented a new Medical Director Training for Ontario, Canada. The response from attendees, the general membership and the LTC Sector have endorsed that this was a much needed resource for Medical Directors in our province. We plan to offer the training on an annual basis. New funding will support the development of a more sophisticated e-learning component for the pre-course work with opportunities over time to build continued learning opportunities to further support peer to peer networking and capacity building.We believe that there is opportunity for this education program to be considered as International Equivalency to the ADMA Core Curriculume supporting peer to peer networking both on a National and International stage. This has the potential to further extend the reach of AMDA. Author Disclosures: All authors have stated there are no financial disclosures to be made that are pertinent to this abstract.
Journal of the American Geriatrics Society, 2013