In:
Journal of the American Geriatrics Society, Wiley, Vol. 65, No. 5 ( 2017-05), p. 1073-1078
Abstract:
To identify features of community nursing home ( NH ) environments associated with lower rates of overall antibiotic use. Design This pilot study used an explanatory sequential design that incorporated comparative feedback about antibiotic use to inform a discussion about antimicrobial stewardship practices in community NH s. Setting NH s. Participants Clinical leadership of five NH s. Measurements For the quantitative phase, the number of antibiotic prescriptions, length of therapy, and days of therapy/1,000 days of care were measured at six NH s. For the qualitative phase, semistructured interviews were conducted with healthcare workers in leadership positions at five community NH s. Transcripts from the recorded interviews were assessed using emergent thematic analysis. For the triangulation phase, themes from the semistructured interviews were evaluated in the context of each NH 's antibiotic use. Results The number of antibiotic prescriptions ranged from 172 to 1,244, with 50% to 83% written for 7 days or fewer. All NH s reported a similar proportion of fluoroquinolone use (27–32% of days of therapy). Triangulation yielded six themes for which the environment at each facility ranged from less‐ to more‐supportive antimicrobial stewardship: practice patterns, external influences, infection control, leadership, communication, and facility culture. All NH s reported pressure from well‐intentioned family members to prescribe antibiotics. NH s with shorter lengths of therapy and lower overall antibiotic use were consonant with an environment more supportive of antimicrobial stewardship. Conclusion These findings suggest several features of NH s that are supportive of antimicrobial stewardship: practice patterns grounded in established diagnostic criteria, proactive infection control and prevention, open communication and interconnectedness among staff.
Type of Medium:
Online Resource
ISSN:
0002-8614
,
1532-5415
DOI:
10.1111/jgs.2017.65.issue-5
Language:
English
Publisher:
Wiley
Publication Date:
2017
detail.hit.zdb_id:
2040494-3
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