Influencing factors on antibiotic prescribing in nursing homes

Abstract

This paper describes a study undertaken to de ne dimensions of antibiotic prescribing in selected nursing homes and to consider the factors which might have an impact on practice.Increasing concerns about antibiotic resistance as a result of inappropriate prescribing was the impetus of the study. Poor interprofessional relationships and inadequate GP visiting arrangements were found to impact on prescribing and patient care. Lack of availability of local sensitivity patterns and inadequate use of the laboratory contribute to the problem. The paper draws conclusions from focus group ndings and makes recommendations which could improve practice.

Workflow Barriers and Strategies to Reduce Antibiotic Overuse in Nursing Homes

“…Conversely, nursing staff noted they lacked confidence in recommending a particular treatment plan or felt that their recommendations would not be well received by the provider. Similar interprofessional concerns have been identified in other studies, 22,23,27,28 and the distrust between nursing staff and providers may hamper efforts to employ antibiotic deferral strategies based on active monitoring in low-risk residents. 29 The barriers we found may be addressed by repurposing existing resources, as shown in Table 3.…”

“…The challenges and complexity of assessing and managing NH resident change in condition attributable to infection has been identified by other investigators. [22][23][24][25][26][27] Nursing staff had a critical role in how antibiotic decisions were made in all of these studies. Our study adds to this literature by describing the steps nursing staff engage in and the barriers arising during several of these steps, which may adversely impact antibiotic decision-making in NHs.…”

“…We found that information sharing across organizational boundaries was a key feature of the antibiotic prescribing process in NHs, which is consistent with other studies. 22,26,28 Nursing staff are rarely able to communicate with providers directly and must often initiate contact through clinical and nonclinical intermediaries or rely on passive communication channels (e.g., fax). These existing interprofessional communication channels increase the risk of delays in care, which may increase hospitalization risk and information decay.…”

Antibiotic Prescribing in Long-Term Care Facilities: A Meta-synthesis of Qualitative Research

“…There were many challenges reported by nurses and doctors in diagnosing patients with infection in LTCFs. The delay in obtaining microbiology results for urine samples was perceived as leading to increased empirical prescribing of antibiotics [ 15 , 17 , 18 , 22 ]. Participants often depend on dipstick test results, interpreting a patient’s change in behaviour or changes in the urine as a UTI [ 18 , 20 ].…”

“…Co-morbidities, such as cognitive impairment and incontinence, challenged the nurses’ and doctors’ ability to diagnose infection and conduct the necessary investigations. Not having a doctor on-site to assess patients as quickly as possible was also identified as a challenge to fast diagnosis and care [ 16 – 18 , 22 ]. Prescribing of antibiotics without assessment by the doctor was referred to in several studies [ 17 , 18 ].…”