The literature cites antibiotics are over prescribed in hospitals and long-term care. As inappropriate antibiotic prescribing continues, antibiotic resistance is a growing concern. Antimicrobial Stewardship Programs (ASPs) have been well established in acute care; however, the literature is limited on ASP in long-term care (LTC). In mid-2012, Baycrest implemented a centre wide ASP, adapting key principles from literature in acute care, to suit the needs, capability and capacity of an LTC setting. The Baycrest Antimicrobial Stewardship Program ensures the most appropriate use of antibiotics at Baycrest.

Along with improving/maintaining resistance, the program aims to improve patient care /safety by reducing unnecessary antibiotic exposure, and therefore risks of the antibiotics themselves (e.g. risk of allergic reaction, side effects and Clostridium difficile diarrhea).

Baycrest’s Stewardship Program is centre-wide, including Baycrest Hospital and Apotex Nursing Home. The program is interdisciplinary and consists of a core team (a stewardship pharmacist and two family doctors) who develop/implement stewardship interventions. Like most long-term care facilities, Baycrest lacked onsite infectious disease expertise when the program began. As such Mount Sinai Hospital was engaged as an external partner to provide direction and support to the Baycrest core team. Infection Prevention and Control, and Information system specialists also provide support.

The stewardship team uses a variety of interventions focusing on education, such as, Baycrest guideline and policy updates, information technology interventions, formulary reviews, prospective audits with feedback, posters, presentations, handouts, displays, etc.

The targeted measurable objective is patient safety through using antibiotics only when needed, and ensuring that when used, it is the most appropriate antibiotic, dose, frequency, and duration. When the decision is made to not use antibiotics, adverse drug reactions are avoided and pressure for antibiotic resistance for future infections is reduced. The Antimicrobial Stewardship Program is evaluated with ongoing metric data collected and reviewed quarterly.

These interventions, targeted towards physicians, pharmacists, nursing staff, and patients/families, have resulted in a decrease in select antibiotic use of over 50% in the hospital, and over 40% in the Nursing Home, and an improvement in antibiotic resistance patterns for some of these antibiotics. Through a reduction in inappropriate antimicrobial usage, the Antimicrobial Stewardship Program has successfully demonstrated innovative collaboration leading to successful implementation of a program and optimized care for LTC patients.

Contact Information:

Contact Title: Antimicrobial Stewardship Pharmacist
Contact Email:
dyang@baycrest.org

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