Successfully Reducing Antibiotic Prescribing in Nursing Homes

Zimmerman, Sheryl; Sloane, Philip D.; Bertrand, Rosanna M.; Olsho, Lauren; Beeber, Anna; Kistler, Christine E.; Hadden, Louise; Edwards, Alrick S.; Weber, David J.; Mitchell, C. Madeline

doi:10.1111/jgs.12784

Cited by 74 publications

(140 citation statements)

References 24 publications

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“…Four out of 12 studies targeted only physicians [42,44,46] or nurses [43]. Six studies involved some feedback to physicians and/or nurses [29,41,42,44,46,48], and five studies performed repeated interactions with physicians and/or nurses [29,42,44,46,48]. Jump et al described the positive impact of an Infectious Diseases (ID) on-site consultation service in a hospital-based American LTCF [2,44], in line with several studies demonstrating the value of ID specialists in acute-care hospitals [49].…”

Section: Interventional Studies Aiming At Improving Antibiotic Use Inmentioning

confidence: 74%

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Strategies and challenges of antimicrobial stewardship in long-term care facilities

Dyar

Pagani

Pulcini

2015

Clinical Microbiology and Infection

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As people are living longer the demand for long-term care facilities (LTCFs) continues to rise. For many reasons, antimicrobials are used intensively in LTCFs, with up to a half of this use considered inappropriate or unnecessary. Over-use of antimicrobials can have direct adverse consequences for LTCF residents and promotes the development and spread of resistant bacteria. It is therefore critical that LTCFs are able to engage in antimicrobial stewardship programmes, which have the potential to minimize the antibiotic selective pressure, while improving the quality of care received by LTCF residents. To date, no antimicrobial stewardship guidelines specific to LTCF settings have been published. Here we outline the scale of antimicrobial use in LTCFs and the underlying drivers for antibiotic over-use. We further describe the particular challenges of antimicrobial stewardship in LTCFs, and review the interventional studies that have aimed to improve antibiotic use in these settings. Practical recommendations are then drawn from this research to help guide the development and implementation of antimicrobial stewardship programmes.

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Section: Interventional Studies Aiming At Improving Antibiotic Use Inmentioning

confidence: 74%

“…Table 2 summarizes all 12 published interventional studies that aimed to improve antibiotic use in LTCFs, of which all but one [43] had an educational component [29,32,[39][40][41][42][44][45][46][47][48].…”

Section: Interventional Studies Aiming At Improving Antibiotic Use Inmentioning

confidence: 99%

Strategies and challenges of antimicrobial stewardship in long-term care facilities

Dyar

Pagani

Pulcini

2015

Clinical Microbiology and Infection

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“…While there is sufficient evidence to develop guidelines in support of antimicrobial stewardship in acute care facilities [3,4], there is limited evidence describing successful antimicrobial stewardship practices in nursing homes [5–8]. There are nearly 1.4 million nursing home residents in the United States [9] and an estimated 10% of them receive antimicrobials each day [10].…”

Section: Introductionmentioning

confidence: 99%

An online course improves nurses' awareness of their role as antimicrobial stewards in nursing homes

Wilson

Shick

Carter

et al. 2017

American Journal of Infection Control

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Background To support the role of nurses as active proponents of antimicrobial stewardship in long-term care facilities, we developed an educational intervention consisting of a free online course comprised of 6 interactive modules. Here, we report the effect of the course on the knowledge, beliefs and attitudes towards antimicrobial stewardship of nurses working in long-term care facilities. Measurements We used a paired pre- and post-course survey instrument to assess nurses’ knowledge regarding the care of long-term care facility residents with infections as well as attitudes and beliefs regarding antimicrobial stewardship. Results 103 respondents, RNs or LPNs, completed the pre and post-surveys. Their mean knowledge scores improved, from 75% (pre-course) to 86% (post-course, P < 0.001). Following the course, nurses’ agreement that their role influences whether or not residents receive antimicrobials increased significantly (P < 0.001). Discussion The online course improves nurses’ knowledge regarding the care of long-term care facility residents with infections and improves their confidence to engage in antimicrobial stewardship activities. Conclusion Empowering nurses to be antimicrobial stewards may help reduce unnecessary antibiotic use among institutionalized older adults.

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“…However, efforts to curb antibiotic use in older adults have primarily targeted physicians and have had limited impact [12, 13]. A possible reason for this lack of antibiotic stewardship in NHs may be a lack of involvement of nursing staff and patient/family in prescribing decisions.…”

Section: Introductionmentioning

confidence: 99%

Nursing home nurses’ and community-dwelling older adults’ reported knowledge, attitudes, and behavior toward antibiotic use

et al. 2017

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BackgroundAntibiotic overuse causes antibiotic resistance, one of the most important threats to human health. Older adults, particularly those in nursing homes, often receive antibiotics when they are not indicated.MethodsTo understand knowledge, attitudes, and behaviors of nursing home (NH) nurses and community-dwelling older adults towards antibiotic use, especially in clinical situations consistent with antibiotic overuse, we conducted a mixed-method survey in two NHs and one Family Medicine clinic in North Carolina, among English-speaking nurses and community-dwelling, cognitively intact adults aged 65 years or older. Based on the Knowledge-Attitude-Practice model, the survey assessed knowledge, attitudes, and behavior towards antibiotic use, including three vignettes designed to elicit possible antibiotic overuse: asymptomatic bacteriuria (ASB), a viral upper respiratory illness (URI), and a wound from a fall.ResultsOf 31 NH nurses and 66 community-dwelling older adults, 70% reported knowledge of the dangers of taking antibiotics. Nurses more often reported evidence-based attitudes towards antibiotics than older adults, except 39% agreed with the statement “by the time I am sick enough to go to the doctor with a cold, I expect an antibiotic”, while only 28% of older adults agreed with it. A majority of nurses did not see the need for antibiotics in any of the three vignettes: 77% for the ASB vignette, 87% for the URI vignette, and 97% for the wound vignette. Among older adults, 50% did not perceive a need for antibiotics in the ASB vignette, 58% in the URI vignette, and 74% in the wound vignette.ConclusionsWhile a substantial minority had no knowledge of the dangers of antibiotic use, non-evidence-based attitudes towards antibiotics, and behaviors indicating inappropriate management of suspected infections, most NH nurses and community-dwelling older adults know the harms of antibiotic use and demonstrate evidence-based attitudes and behaviors. However, more work is needed to improve the knowledge, attitudes and behaviors that may contribute to antibiotic overuse.

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Successfully Reducing Antibiotic Prescribing in Nursing Homes

Cited by 74 publications

References 24 publications

Strategies and challenges of antimicrobial stewardship in long-term care facilities

Strategies and challenges of antimicrobial stewardship in long-term care facilities

An online course improves nurses' awareness of their role as antimicrobial stewards in nursing homes

Nursing home nurses’ and community-dwelling older adults’ reported knowledge, attitudes, and behavior toward antibiotic use

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