Abstract
Objective
To evaluate a bundled electronic intervention to improve antibiotic prescribing practices
in US nursing homes.
Design
Prospective mixed-methods quality improvement intervention.
Setting and Participants
Nursing staff and residents in 13 nursing homes, and residents in 8 matched-control
facilities (n = 21 facilities total, from 2 corporations).
Methods
This study involved a 2-month design period (n = 5 facilities) focused on the acceptability
and feasibility of a bundled electronic intervention consisting of 3 tools, followed
by a 15-month implementation period (n = 8 facilities) during which we used rapid-cycle
quality improvement methods to refine and add to the bundle. We used mixed-methods
data from providers, intervention tools, and health records to assess feasibility
and conduct a difference-in-difference analysis among the 8 intervention sites and
8 pair-matched controls.
Results
Nurses at 5 pilot sites reported that initial versions of the electronic tools were
acceptable and feasible, but barriers emerged when 8 different facilities began implementing
the tools, prompting iterative revisions to the training and bundle. The final bundle
consisted of 3 electronic tools and training that standardized digital documentation
to document and track a change in resident condition, infections, antibiotic prescribing,
and antibiotic follow-up. By the end of the implementation phase, all 8 facilities
were using at least 1 of the 3 tools. Early antibiotic discontinuation increased 10.5%
among intervention sites, but decreased 10.8% among control sites.
Conclusions and Implications
The 3 tools in our bundled electronic intervention capture clinical and prescribing
data necessary to assess changes in antibiotic use and were feasible for nurses to
adopt. Achieving this required modifying the tools and training before the intervention
reached its final form. Comparisons of rates of antibiotic use at intervention and
control facilities showed promising improvement in antibiotic discontinuation, demonstrating
that the intervention could be evaluated using secondary electronic health record
data.
Keywords
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References
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Article info
Publication history
Published online: September 07, 2021
Footnotes
Robin Jump is principal investigator on research grants from Pfizer and Accelerate; she has also participated in advisory boards for Pfizer and Merck. Stefan Gravenstein is principal investigator on research grants supported by Sanofi, Seqirus, Sunovion, and Pfizer and consultant to Sanofi and Janssen. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Identification
Copyright
© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
ScienceDirect
Access this article on ScienceDirectRelated Podcast
June 15, 2022
June 2022 Issue: Drug Prescribing Dilemmas in Geriatric Medicine
Host: Dr. Karl Steinberg. Featuring Dr. Philip Sloane, Dr. Mallory Brown, special guest: Josh Niznik, PharmD. Recorded on May 25, 2022.
https://mcdn.podbean.com/mf/download/trnufq/JOTG-2022-06-22_mixdown.mp3
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