Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-23T08:21:47.456Z Has data issue: false hasContentIssue false
  • English
  • Français

Antibiotic Prescribing in 4 Assisted-Living Communities: Incidence and Potential for Improvement

Published online by Cambridge University Press:  10 May 2016

Philip D. Sloane ,
Sheryl Zimmerman ,
David Reed ,
Anna Song Beeber ,
Latarsha Chisholm ,
Christine Kistler ,
Christine Khandelwal ,
David J. Weber  and
C. Madeline Mitchell
Philip D. Sloane
Affiliation:
Department of Family Medicine, University of North Carolina at Chapel Hill, North Carolina Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, North Carolina
Sheryl Zimmerman
Affiliation:
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, North Carolina School of Social Work, University of North Carolina at Chapel Hill, North Carolina
David Reed
Affiliation:
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, North Carolina
Anna Song Beeber
Affiliation:
School of Nursing, University of North Carolina at Chapel Hill, North Carolina
Latarsha Chisholm
Affiliation:
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, North Carolina
Christine Kistler
Affiliation:
Department of Family Medicine, University of North Carolina at Chapel Hill, North Carolina
Christine Khandelwal
Affiliation:
Department of Family Medicine, University of North Carolina at Chapel Hill, North Carolina
David J. Weber
Affiliation:
Department of Medicine, University of North Carolina at Chapel Hill, North Carolina
C. Madeline Mitchell
Affiliation:
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, North Carolina
Rights & Permissions [Opens in a new window]

Extract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective.

To describe the prevalence, characteristics, and appropriateness of systemic antibiotic use in assisted living (AL) and to conduct a preliminary quality improvement intervention trial to reduce inappropriate prescribing.

Design.

Pre-post study, with a 13-month intervention period.

Setting.

Four AL communities.

Participants.

All prescribers, all AL staff who communicate with prescribers, and all patients who had an infection during the baseline and intervention periods.

Intervention.

A standardized form for AL staff, an online education course and 5 practice briefs for prescribers, and monthly quality improvement meetings with AL staff.

Measurements.

Monthly inventory of all systemic antibiotic prescriptions; interviews with the prescriber, AL staff member, closest family member, and patient (when capable) regarding 85 antibiotic prescribing episodes (30 baseline, 55 intervention), with data review by an expert panel to determine prescribing appropriateness.

Results.

The mean number of systemic antibiotic prescriptions was 3.44 per 1,000 resident-days at baseline and 3.37 during the intervention, a nonsignificant change (P = .30). Few prescribers participated in online training. AL staff use of the standardized form gradually increased during the program. The proportion of prescriptions rated as probably inappropriate was 26% at baseline and 15% during the intervention, a nonsignificant trend (P = .25). Drug selection was largely appropriate during both time periods.

Conclusions.

AL antibiotic prescribing rates appear to be approximately one-half those seen in nursing homes, with up to a quarter being potentially inappropriate. Interventions to improve prescribing must reach all physicians and staff and most likely will require long time periods to have the optimal effect.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue S3: Preventing Healthcare–Associated Infections: Results and Lessons Learned from AHRQ's HAI Program , October 2014 , pp. S62 - S68
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

References

1. Neu, HC. The crisis in antibiotic resistance. Science 1992; 257(5073):1064–1073.Google Scholar
2. Croft, AC, D'Antoni, AV, Terzulli, SL. Update on the antibacterial resistance crisis. Med Sci Monit 2007;13(6):RA103–RA118.Google Scholar
3. Gonzales, R, Steiner, JF, Lum, A, et al. Decreasing antibiotic use in ambulatory practice: impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults. JAMA 1999;281(16):1512–1519.Google Scholar
4. Warren, JW, Palumbo, FB, Fitterman, L, et al. Incidence and characteristics of antibiotic use in aged nursing home patients. J Am Geriatr Soc 1991;39(10):963–972.Google Scholar
5. Katz, PR, Beam, TR Jr, Brand, F, et al. Antibiotic use in the nursing home: physician practice patterns. Arch Intern Med 1990;150(7): 1465–1468.Google Scholar
6. Benoit, SR, Nsa, W, Richards, CL, et al. Factors associated with antimicrobial use in nursing homes: a multilevel model, J Am Geriatr Soc 2008;56(11):2039–2044.Google Scholar
7. Mylotte, JM, Keagle, J. Benchmarks for antibiotic use and cost in long-term care. J Am Geriatr Soc 2005;53(7):1117–1122.Google Scholar
8. Nicolle, LE, Bentley, DW, Garibaldi, R, et al; SHEA Long-Term-Care Committee. Antimicrobial use in long-term-care facilities. Infect Control Hosp Epidemiol 2000;21(8):537–545.Google Scholar
9. Zimmer, JG, Bentley, DW, Valenti, WM, et al. Systemic antibiotic use in nursing homes: a quality assessment, J Am Geriatr Soc 1986;34(10):703–710.Google Scholar
10. US Department of Health and Human Services. National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination. Chapter 10, “Long-Term Care Facilities.” http://www.hhs.gov/ash/initiatives/hai/actionplan/ltc_facili ties508.pdf. Published 2013. Accessed December 21, 2013.Google Scholar
11. Loeb, M, Brazil, K, Lohfeld, L, et al. Effect of a multifaceted intervention on number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes: cluster randomised controlled trial. BMJ 2005;331(7518):669A–672A.Google Scholar
12. Schwartz, DN, Abiad, H, DeMarais, PL, et al. An educational intervention to improve antimicrobial use in a hospital-based LTC facility. J Am Geriatr Soc 2007;55(8): 1236–1242.Google Scholar
13. Monette, J, Miller, MA, Monette, M, et al. Effect of an educational intervention on optimizing antibiotic prescribing in LTC facilities. J Am Geriatr Soc 2007;55(8):1231–1235.Google Scholar
14. National Center for Health Statistics. Fast Stats A to Z. http://www.cdc.gov/nchs/fastats/nursingh.htm. Published 2013. Accessed December 21, 2013.Google Scholar
15. Park-Lee, E, Caffrey, C, Sengupta, M, et al. Residential care facilities: a key sector in the spectrum of long-term care providers in the United States. NCHS Data Brief 2011;(78):1–8.Google Scholar
16. Zimmerman, S, Gruber-Baldini, AL, Sloane, PD, et al. Assisted living and nursing homes: apples and oranges? Gerontologist 2003:43(suppl 2):107–117.Google Scholar
17. Zimmerman, S, Mitchell, CM, Beeber, AS, et al. Strategies to reduce potentially inappropriate antibiotic prescribing in assisted living and nursing homes. Adv Prev Control Healthc Assoc Infect (forthcoming).Google Scholar
18. Tsan, L, Langberg, R, Davis, C, et al. Nursing home-associated infections in Department of Veterans Affairs community living centers. Am J Infect Control 2010;38(6):461–466.Google Scholar
19. Nicolle, LE. Asymptomatic bacteriuria: when to screen and when to treat. Infect Dis Clin North Am 2003;17(2):367–394.Google Scholar
20. Sibbald, RG, Woo, K, Ayello, EA. Increased bacterial burden and infection: the story of NERDS and STONES. Adv Skin Wound Care 2006;19(8):447–461.Google Scholar
21. Arroll, B, Kenealy, T, Falloon, K. Are antibiotics indicated as an initial treatment for patients with acute upper respiratory tract infections? a review. N Z Med J 2008;121(1284):64–70.Google Scholar
22. Smucny, JJ, Becker, LA, Glazier, RH, et al. Are antibiotics effective treatment for acute bronchitis? a meta-analysis. J Fam Pract 1998;47(6):453–460.Google Scholar
23. Pennsylvania Patient Safety Authority. 2009 Annual Report. http://patientsafetyauthority.org/Documents/Annual_Report_2009.pdf. Published 2010. Accessed December 21, 2013.Google Scholar
24. Stevenson, KB, Moore, J, Colwell, H, et al. Standardized infection surveillance in long-term care:interfacility comparisons from a regional cohort of facilities. Infect Control Hosp Epidemiol 2005; 26(3):231–238.Google Scholar
25. Koch, AM, Eriksen, HM, Elstrøm, P, et al. Severe consequences of healthcare-associated infections among residents of nursing homes: a cohort study. J Hosp Infect 2009;71(3):269–274.Google Scholar
26. Loeb, M, Bentley, DW, Bradley, S, et al. Development of minimum criteria for the initiation of antibiotics in residents of long-term-care facilities: results of a consensus conference. Infect Control Hosp Epidemiol 2001;22(2): 120–124.Google Scholar
27. Juthani-Mehta, M, Tinetti, M, Perrelli, E, et al. Diagnostic accuracy of criteria for urinary tract infection in a cohort of nursing home residents. J Am Geriatr Soc 2007;55(7):1072–1077.Google Scholar
28. Anderson, RA, Issel, LM, McDaniel, RR Jr. Nursing homes as complex adaptive systems: relationship between management practice and resident outcomes. Nurs Res 2003;52(1):12–21.Google Scholar