The mission of Expert Stewardship, Inc. is to establish, support and maintain antimicrobial stewardship programs in long-term care facilities nationwide. We will use the latest developments in performance improvement and medical research to improve clinical outcomes, minimize development of antimicrobial resistance and reduce costs through proper use of antimicrobials.


Centers for Medicare & Medicaid Services (CMS) and individual state law (California Senate Bill 361require that all long-term care facilities adopt and implement antimicrobial stewardship systems that are consistent with guidelines developed by the Centers for Disease Control and Prevention (CDC), the Centers for Medicare and Medicaid Services (CMS), the Society for Healthcare Epidemiology of America (SHEA), the Infectious Disease Society of America (IDSA) or similarly recognized professional organizations.  

Our expert team assists long-term care facilities anywhere in the nation comply with these requirements using the following strategies:


Baseline antibiotic usage data, resistance patterns and patient outcomes form the foundation for effective stewardship.  Our training in infectious diseases, pharmacy and infection prevention combined with our antibiotic expertise allow us to rapidly develop targeted, effective interventions specific to each facility. Goals include reductions in laboratory testing costs,  hospital readmission rates, antibiotic associated harm such as Clostridium difficile, antimicrobial resistance and improved resident health and satisfaction.


Education is one of our most important interventions.  Education is provided in person and also through this website.  As experts in our fields, we have the credibility to educate providers, change prescribing practices and implement a comprehensive suite of best practices. Facility specific Interventions may target opportunities such as unnecessary antibiotic exposure, laboratory testing, antibiotic cost and infection related outcomes.   The highest value interventions are initiated first so each facility should quickly realize some return on their stewardship program investment.  Using our training in Quality Assurance and Performance Improvement (QAPI) and Six Sigma including DMAIC (Define, Measure, Analyze, Improve, Control) methodology, the effects of interventions are monitored and used to refine an intervention and/or develop new strategies and initiatives.



By following our comprehensive and data driven approach, our facilities are experiencing reductions in unnecessary antibiotic prescriptions especially for Fluoroquinolones and antibiotic new starts for residents that do not meet McGeer critieria.  As a result, our facilities have had a reduction in Clostridium difficile infections and antibiotic expenditure.  Reductions in laboratory testing costs,  hospital readmission rates, antibiotic associated harm such as antimicrobial resistance and improved resident health and satisfaction may follow.  See examples of actual results here.

We work nationwide with individual facilities either in person or remotely. We have the capability to guide stewardship development, implementation and maintenance across an entire system of facilities which adds value and allows standardization.