Massachusetts Pioneers Antimicrobial Stewardship in Nursing Homes
A statewide antimicrobial stewardship program in Massachusetts has provided valuable insights into implementing such initiatives within nursing home settings. This program, launched in 2018, marks a significant collaborative effort to improve antibiotic prescribing practices in long-term care facilities.
The program, launched in 2018 by the Massachusetts Department of Health in collaboration with Tufts Medical Center, established a standardized system for tracking antibiotic initiation in long-term care (LTC) facilities.
Program Foundation and Objectives
Antibiotics are frequently prescribed in nursing homes, with a significant portion of these prescriptions often deemed unnecessary. To address this critical issue, the Massachusetts Antibiotic Start (AS) benchmarking initiative was introduced.
Through a multi-component strategy including educational outreach and structured office hours, the program aimed to achieve two key objectives: enhance data transparency and guide improvement efforts in antibiotic use across facilities.
Key Data and Shifting Prescribing Patterns (2018-2024)
Data was submitted by 217 Massachusetts LTC facilities from 2018 through 2024, providing a comprehensive look at antibiotic prescribing trends over a six-year period.
During this timeframe, the overall AS rate experienced a modest increase. The overall AS rate increased by 7%, from 7.22 to 7.70 starts per 1,000 resident-days. However, more targeted changes in the types of antibiotics prescribed demonstrated positive stewardship outcomes.
Fluoroquinolone starts decreased by 36%, while beta-lactam starts increased by 26%.
Interpreting the Success
Researchers noted that the decline in fluoroquinolone use and the concurrent rise in beta-lactam prescribing align with intended stewardship outcomes, indicating safer, guideline-concordant prescribing practices. This shift is considered beneficial as fluoroquinolones are often associated with higher risks of side effects and the development of antibiotic resistance, whereas beta-lactams are generally preferred for many common infections.
The program's success highlights the feasibility of antimicrobial stewardship in LTC through sustained public health-academic collaboration and a multi-component strategy. This collaborative model offers valuable lessons for other regions seeking to implement effective antimicrobial stewardship initiatives within vulnerable populations.