Toolkit 3. Minimum Criteria for Common Infections Toolkit

Toolkit Effectiveness

The design and information in the toolkit is based on published expert consensus^1-2. The Suspected UTI SBAR Form and the letter were tested in Texas and resulted in a 30% reduction of use in unnecessary antibiotics.³

Overview of the Toolkit

What Is the Minimum Criteria for Common Infections Toolkit and Why Should a Nursing Home Use This Toolkit?

Between 25 percent and 75 percent of antibiotic prescriptions in nursing homes do not meet clinical guidelines for prescribing. Unnecessary antibiotics can result in side effects and drug-resistant bacteria. The Minimum Criteria for Common Infections toolkit (“Minimum Criteria toolkit”) aims to reduce unnecessary prescribing for the three infections where antibiotics are most frequently prescribed in nursing homes: (1) urinary tract infections (UTIs), (2) lower respiratory tract infections, and (3) skin and soft tissue infections.

What is Included in the Toolkit?

The toolkit is intended to help prescribing clinicians (physicians, nurse practitioners, and physician assistants) determine when antibiotics are truly needed. This toolkit includes the following tools, and it is up to nursing home staff to choose which one(s) to implement:

• A sample policy for the nursing home's records (tool 1).  (PDF | Word)
• Suspected infection SBAR forms to document information for prescribing clinicians (tool 2). SBAR stands for Situation, Background, Assessment, and Request.
  • Suspected UTI SBAR (PDF) 
  • Suspected Lower Respiratory Tract Infection SBAR (PDF) 
  • Suspected Skin and Soft Tissue Infection SBAR (PDF)
• A mobile Web site/Web application presenting the decisionmaking tree for prescribing clinicians (tool 3).
• A letter for prescribing clinicians that outlines the new policy for prescribing clinicians (tool 4). (PDF | Word)
• Training for nursing staff on the importance of and how to use the forms for prescribing clinicians (tool 5). (PPTX | Word)

How Do I Implement the Toolkit?

Implementing the toolkit involves five steps:

1. Incorporate the communication tools into standard practice. Incorporating communication tools and related policies into standard practice is much more likely to result in staff using the tools regularly. A draft policy is included.
    
2. Introduce the toolkit to prescribing clinicians. Using a letter describing the new protocol, a nursing home can help prescribing clinicians familiarize themselves with the new protocol and communication tools, as well as the rationale and value of the tools. This will help prescribing clinicians follow the guidelines and prepare them to expect the nursing staff to present infection-related information in this format. The letter can also be adapted for clinicians at hospitals who treat or refer residents.
    
3. Train nursing staff to use the tools. Training increases staff understanding of inappropriate antibiotic use and of the tools available to them. Conducting this training is important because staff are more likely to use tools they understand and know how to use. Training should include information on inappropriate antibiotic use, a description of the tools and how to use them, and a discussion about scientific evidence for the recommended best practices. A periodic refresher training is also helpful as a reminder to staff and to make sure new staff understand how to use the tool.
    
4. Incorporate the potential infection SBAR forms into daily practice. The forms can be faxed or used as discussion points for phone or face-to-face conversations with prescribing clinicians. They should be available to the nursing staff responsible for communicating potential infection information to prescribing clinicians. For UTIs, lower respiratory tract infections, and skin and soft tissue infections, a form should be used when contacting the prescribing clinician.
    
5. Refer to the Minimum Criteria App. When considering an antibiotic, prescribing clinicians need easy access to information required for evidence-based prescribing. The Minimum Criteria App facilitates decisionmaking regarding the three most common infections in a nursing home. The app leads the user through questions to identify whether an antibiotic is necessary and offers options for surveillance.

¹Abt Associates and UNC Chapel Hill. Standardizing antibiotic use in long-term care settings (SAUL study). Final report prepared for Agency for Healthcare Research and Quality, Contract HHSA290200600019i, Task Order 11; 2012.

² Stone ND, Ashraf MS, Calder J, et al; Society for Healthcare Epidemiology Long-Term Care Special Interest Group. Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria. Infect Control Hosp Epidemiol. 2012 Oct;33(10):965-77. PMID: 22961014.

³ American Institutes for Research, the Texas A & M University School of Rural Public Health, and TMF Health Quality Institute. Standardizing antibiotic use in long-term care settings (SAUL study). Final Report prepared for Agency for Healthcare Research and Quality, Contract 2902006000191, Task Order 8; 2012.

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