In 2014, the Pennsylvania Patient Safety Authority surveyed long term care facilities statewide about antibiotic stewardship. Of 109 responding facilities, 36.6 percent said they have an antibiotic stewardship program in place, and 46.5 percent said that they were interested in participating in a statewide or regional antibiotic stewardship collaboration.

“Passion about antibiotic stewardship is slowly filtering out there. However, there are several barriers in long term care—such as lack of resources of onsite champions,” says Sharon Bradley of the Pennsylvania Patient Safety Authority. “This is a physician-directed topic that depends on the passion of the facility medical director.”

In 2015, the PA Patient Safety Authority analyzed questionnaire responses from 12 hospitals and 12 long term care (LTC) facilities. They found that hospitals were further along in implementing core antibiotic stewardship elements. Both hospitals and LTC facilities identified incorporating stewardship-related tasks in job descriptions and performance reviews as the greatest opportunity for leadership improvement.

“It is essential to enable leaders and gain their buy-in. They are who staff will listen to—they have to talk the talk and walk the walk,” says Bradley. While both hospitals and LTC facilities identified lack of funding and lack of time as most common barriers to antibiotic stewardship, facilities also reported lack of education as a key challenge. “Our survey results suggest that LTC facilities face a greater challenge than hospitals,” says Bradley. “Compared to hospitals, they are resource-poor in the area of antibiotic stewardship. However, the incentive is there now to look at this issue.”

The good news, Bradley says, is that facilities “don’t have to reinvent the wheel” when it comes to education and training. “There are many excellent resources available on antibiotic stewardship strategies and how to implement them,” she says.

Bradley suggests that nursing care centers can improve prescribing habits by implementing strategies that impact three key motivators: the prescriber’s belief that incorrect use of antibiotics contributes to the spread of multidrug-resistant organisms and C. difficile, that antibiotic stewardship is valued by all stakeholders, and that he or she has the necessary resources to build an effective stewardship program.