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What Toolkits Does the Guide Include?

The toolkits cover a variety of interventions that nursing homes can use to improve antibiotic use.

1. Toolkits To Implement, Monitor, and Sustain an Antimicrobial Stewardship Program

   Most nursing homes will need a team of people to organize stewardship activities and monitor progress toward improving antibiotic use. This section contains two toolkits:

   • The Start an Antimicrobial Stewardship Program toolkit provides guidance and tools for establishing a new antimicrobial stewardship program in a nursing home. An antimicrobial stewardship program uses collaborative and evidence-based approaches to improve antibiotic use by getting residents the right antibiotics, when they need them.
   • The Monitor and Sustain Stewardship toolkit provides guidance and tools for tracking progress toward meeting antimicrobial stewardship program goals and providing feedback to prescribing clinicians.
      
2. Toolkits To Determine Whether It Is Necessary To Treat a Potential Infection With Antibiotics

   A key to improving antibiotic use is making sure residents only receive antibiotics when they need them. This section contains three toolkits:

   • The Suspected UTI SBAR toolkit provides guidance and tools for improving the use of antibiotics for urinary tract infections (UTIs) in nursing home residents based on the Situation, Background, Assessment, and Request (SBAR) format. It is the simplest toolkit to adopt.
   • The Communicating and Decisionmaking for Four Infections toolkit provides guidance and tools for improving the use of antibiotics in the four types of infections where antibiotics are most frequently used in nursing homes: UTIs, lower respiratory infections, skin and soft tissue infections, and gastrointestinal infections. This toolkit may be used instead of the Suspected UTI SBAR toolkit to target additional situations in which antibiotics may be overused.
   • The Minimum Criteria for Common Infections toolkit provides guidance and tools—including a Web app with a diagnostic guidance tool for prescribing clinicians—to improve the use of antibiotics for three common infections: UTIs, lower respiratory infections, and skin and soft tissue infections. Nursing homes can use this toolkit to target these common infections when nursing home leaders want to use a model similar to the Suspected UTI SBAR toolkit.
   • The Minimum Criteria for Antibiotics Tool is the diagnostic guidance tool for prescribing clinicians described in the Minimum Criteria for Common Infections toolkit above.

3. Toolkits To Help Prescribing Clinicians Choose the Right Antibiotic for Treating an Infection

   Nursing homes can create an antibiogram, which is a tool used to document the strains of bacteria present in cultures from residents in the nursing home and the antibiotic susceptibility of those bacteria. Prescribing clinicians can then use the antibiogram to help them choose the most appropriate antibiotic for each infection. Nursing homes can also use the antibiogram to monitor antimicrobial stewardship and provide feedback to clinicians about their prescribing practices.

   This section contains three toolkits for establishing the use of an antibiogram in the nursing home:

   • The Working with a Lab to Improve Antibiotic Prescribing toolkit provides guidance and tools to help a nursing home obtain an antibiogram from its laboratory and use it to improve clinician prescribing practices.
   • The Concise Antibiogram toolkit (Using Nursing Home Antibiograms to Choose the Right Antibiotic) provides guidance and tools to help a nursing home create its own antibiogram based on lab results.
   • The Comprehensive Antibiogram toolkit (The Nursing Home Antibiogram Program Toolkit: How to Develop and Implement an Antibiogram Program) provides detailed and comprehensive information and tools for creating a complete antimicrobial stewardship program that is built around the use of an antibiogram. It includes a readiness assessment, timeline, policies and procedures, and monitoring tools specific to the antibiogram.
      
4. Toolkit To Educate and Engage Residents and Family Members

   Residents and their family members may not know how antibiotics should be used or understand the risks associated with antibiotic use. Educating residents and their family members about these issues helps them understand what the nursing home is doing to make sure antibiotics are used properly, what the risks of taking antibiotics are, and what they can do to be engaged in decisions about their care. This section contains one toolkit that provides guidance and tools for educating residents and their family members about antibiotics and engaging them in health care decisions.