03/21/2024

Survey Tip of the Week: Antibiotic Time Out

F-881 Antibiotic Stewardship Program (ASP) citations in Ohio are frequently a result of prescribing antibiotics unnecessarily and the failure of the ASP to monitor and review antibiotic use to determine if the antibiotic is still indicated or if adjustments should be made (e.g., antibiotic time-out).

An antibiotic “time out” is a formal process designed to prompt a reassessment of the ongoing need for and choice of an antibiotic once more data is available. CMS recommends facilities use the Centers for Disease Control and Prevention’s (CDC) “The Core Elements of Antibiotic Stewardship for Nursing Homes” guide.  In this guide, CDC notes that antibiotics are often started empirically in nursing home residents when the resident has a change in physical or mental status while diagnostic information is being obtained. However, providers often do not revisit the selection of the antibiotic after more clinical and laboratory data (including culture results) become available. ODH citation examples included not reviewing antibiotic orders upon admission or readmission and upon record review there was not an indication for use based on evidenced-based criteria.

CMS in the State Operations Manual Appendix PP  states that the facility must incorporate monitoring of antibiotic use, including the frequency of monitoring/review. Monitor/review response to antibiotics, and laboratory results when available, to determine if the antibiotic is still indicated or adjustments should be made (e.g., antibiotic time-out); when the resident is new to the facility; when a prior resident returns or is transferred from a hospital or other facility.

CMS also recommends facilities utilize the Agency for Healthcare Research and Quality’s “Nursing Home Antimicrobial Stewardship Guide.” Facilities should consider using the Infection Prevention, Control & Immunizations survey pathway to evaluate compliance with the regulation. 

This survey pathway can be found in the Survey Resources zip file on the CMS Nursing Home webpage and under the downloads section on this CMS webpage. The State Operations Manual Appendix PP provides additional guidance on the antibiotic stewardship program.   

LeadingAge has developed webinars and resources on the requirements of participation which are located on the LeadingAge learning hub. LeadingAge continues to add QuickCasts on the regulatory groups.  Updated resources have also been added on the Nursing Home RoP Tools and Resources webpage.  

For more information about the updated requirements of participation and citations occurring in Ohio, please join us on the monthly STAT: Survey Tips and Tactics call. Register now for the April 10 call at 11:00AM. LeadingAge Ohio is sharing tips to assist members during the survey process. Send questions you would like addressed in future Tips of the Week to Stephanie DeWees at sdewees@leadingageohio.org.