| Philosophy of Care |
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Leadership engagement and commitment |
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Set a facility-wide expectation for evidence-based clinical and diagnostic criteria before starting antibiotics. Engage covering providers familiar with the care of nursing home residents. Foster longevity among staff to support “institutional memory” and consistent practice patterns.
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Ownership and sense of responsibility by all staff |
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Minimize hierarchy among staff. Cultivate opportunities for nurses, nurses aides and providers to work as teams. Schedule daily to weekly meetings by a multidisciplinary team to discuss residents with changes in clinical status. Develop and communicate strategies to address requests for antibiotics by family members and to review antibiotics prescribed by external providers.
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| Task Oriented |
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Ongoing education activities for all staff |
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Frequent (i.e., quarterly) and recurring in-service training on a range of infection control and prevention topics, such as hand hygiene to use of personal protective equipment. Training in the use of standardized assessment tools to facilitate communication between nursing staff and providers. Support antimicrobial stewardship education for providers.
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Regularly share process measures with all staff |
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Share the NH’s rate of infections over time and, if appropriate, by unit. Share the rate of antibiotic prescriptions that did and did not meet established surveillance criteria for infections.
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Compare outcomes to that of other NHsb
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Comparative feedback common infections, prevention measures and surveillance outcomes for drug-resistant pathogens and C. difficile [24]. Comparative feedback about antibiotic use within a region, chain or network of NHs.
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