Why Antibiotic Stewardship Matters in Nursing Homes

Antibiotics are among the most commonly prescribed medications in nursing homes. While these drugs are vital for treating and preventing life-threatening infections, their inappropriate use can lead to serious problems. Overuse of antibiotics can cause adverse drug reactions, increase antimicrobial resistance, and lead to dangerous infections such as Clostridium difficile (C. diff). To protect residents, facilities must adopt a thoughtful antibiotic stewardship strategy that balances effective treatment with safety. Nursing home antibiotic stewardship programs are a proven way to improve prescribing practices and reduce these risks. This blog explores what antibiotic stewardship means, its core elements, and real-world examples from nursing homes.

Case Study: The Cost of Misuse - An Elderly Resident’s Experience

An 89-year-old woman has lived at Green Pines Care Center for three years. She was admitted due to dementia and her inability to live independently. During episodes of agitation, staff often requested urinary tract infection (UTI) testing. Over the past year, she was treated for a UTI six times, based only on urinalysis results—not culture confirmation. Two weeks after her most recent course of antibiotics, she developed abdominal pain, fever, and diarrhea. She was soon diagnosed with a C. diff infection, a common complication linked to unnecessary antibiotic use. This highlights the need for stronger antimicrobial stewardship in long-term care.

What is Antibiotic Stewardship? Defining Stewardship and Its Impact on Resident Safety

Antibiotic stewardship refers to a coordinated set of practices aimed at optimizing infection treatment while reducing risks associated with antibiotic use. Nursing homes play a critical role in stewardship since up to 70% of residents receive at least one antibiotic each year. Research shows that many of these prescriptions may be unnecessary or inappropriate.

Although antibiotics remain essential for managing severe infections, they also pose risks such as allergic reactions, antimicrobial resistance, and C. diff infections. Antimicrobial resistance occurs when bacteria adapt and no longer respond to standard antibiotics, often due to overuse or misuse. Strong stewardship programs help ensure antibiotics are used only when necessary, protecting residents and preserving treatment effectiveness.

Core Elements of Antibiotic Stewardship Programs: The CDC’s Seven Pillars of Success

• Leadership Commitment – Administrative support and a culture of safe prescribing
• Accountability – Designated leaders such as a medical director, director of nursing, or infection preventionist
• Drug Expertise – Access to pharmacists or infectious disease specialists
• Action – Policies and practices that improve prescribing decisions
• Tracking – Monitoring antibiotic use and outcomes
• Reporting – Regular feedback for prescribers and staff
• Education – Ongoing training for staff, residents, and families

Practical Tools to Strengthen Antibiotic Stewardship Efforts

The Agency for Healthcare Research and Quality (AHRQ) offers practical resources to support nursing homes. One key framework is the Four Moments of Antibiotic Decision Making, which guides clinicians in evaluating whether antibiotics are truly needed. AHRQ also provides SBAR (Situation, Background, Assessment, Recommendation) templates that help staff properly assess suspected infections. Nursing homes can further promote antibiotic stewardship by using public commitment letters to show residents and families their dedication to safe antibiotic use.

How Antibiotic Stewardship Programs Improve Outcomes

AHRQ’s Safety Program for Improving Antibiotic Use tested stewardship strategies in nursing homes over 12 months. Facilities received education through webinars, posters, and expert coaching. The results were encouraging: a 5% reduction in antibiotic starts and total therapy days. This demonstrates how structured antibiotic stewardship programs can significantly improve care quality and reduce unnecessary prescriptions.

Overcoming Barriers to Antibiotic Stewardship in Long-Term Care

Implementing antibiotic stewardship in nursing homes can be challenging. Implementing antibiotic stewardship in long-term care facilities requires overcoming resource challenges. Staffing shortages and high turnover often limit the time available for training and program adoption. Data collection and monitoring are also difficult for facilities with limited resources. Despite these barriers, nursing homes can use telehealth services, interdisciplinary collaboration, and support from state health departments to strengthen stewardship programs. Overcoming these challenges ensures residents receive safer, more effective care.

Moving Forward: Safer Antibiotic Use in Nursing Homes

Strong antibiotic stewardship programs help nursing homes improve resident safety, reduce the risk of antibiotic resistance, and prevent C. diff infections. Leaders and clinicians should prioritize stewardship by adopting the CDC’s core elements and using available toolkits to guide implementation. By taking these steps, facilities can ensure antibiotics remain effective while protecting the health of their residents.

Resources

• https://www.ahrq.gov/antibiotic-use/long-term-care/improve/program.html
• https://www.ahrq.gov/antibiotic-use/long-term-care/improve/program.html
• https://www.ahrq.gov/antibiotic-use/acute-care/four-moments/index.html

Frequently Asked Questions

• How common is antibiotic overuse in nursing homes? Studies have shown that up to 70% of nursing home residents receive at least one course of antibiotics every year and 40-75% of these antibiotics might be inappropriate.
• Who should be involved in implementing antibiotic stewardship in nursing homes The key individuals involved in antibiotic stewardship implementation in nursing homes include the medical director, director of nursing, and the infection preventionist. All staff members play a role in ensuring antibiotic stewardship practices are successful, however.
• How can nursing homes implement antibiotic stewardship with limited resources?Nursing homes can launch an antibiotic stewardship program with just 1 or 2 activities such as tracking types of infections and antibiotic use in the facility. Once these activities are successful, they can be expanded.
• How can residents and families be involved in antibiotic stewardship efforts?Families and residents should receive education and communication on the risks associated with antibiotic use. Staff should post educational materials about antibiotic stewardship in the facility and encourage questions from families and residents.