Implementation

During the Engagement phase, a SNF Infection Preventionist or AZ-ASCEND Coordinator will initiate dialog with SNF leadership. SNF leadership are educated on CMS requirements and facility benefits. Expectations and program timeline are outlined. A designated staff person is assigned to lead monthly data aggregation and report dissemination.

Clinical training and data feedback are implemented in parallel (Figure 1). During Clinical Training staff receive 20-25-minute in-services remotely or in-person. Trainings are available via pre-recorded webinars or can be conducted interactively using our publicly available slide set. Biweekly training topics are consolidated into a review of active observation as an alternative to empiric antibiotics, myths associated with prophylactic antibiotics, and stewardship in a post-COVID era. Follow-up modules are hosted remotely to test knowledge and discuss ASP challenges.

Data Feedback reports are populated using facility-wide metrics including C. Difficile orders, ESBL producing isolates, and resident-based medical activities including UTI cultures ordered, antibiotics prescribed, and clinical symptoms. Data populate feedback reports – including an initial prescriber letter, an initial prescribing report, and quarterly reports– which provide feedback on prescribing trends. Reports are generated using the open-source R and Rstudio software’s. Alternative templates may also be edited manually using a word processor. Facilities can alternatively track antimicrobial use data on spreadsheets. An ordered list of our ASP activities are provided in Figure 1.