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1. Successfully reducing antibiotic prescribing in nursing homes.

Author

Zimmerman S, Sloane PD, Bertrand R, Olsho LE, Beeber A, Kistler C, Hadden L, Edwards A, Weber DJ, and Mitchell CM

Subjects
Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents adverse effects, Female, Follow-Up Studies, Humans, Incidence, Infections epidemiology, Male, Middle Aged, North Carolina epidemiology, Retrospective Studies, Young Adult, Anti-Bacterial Agents administration & dosage, Guideline Adherence statistics & numerical data, Inappropriate Prescribing statistics & numerical data, Infections drug therapy, Nursing Homes organization & administration, Practice Patterns, Physicians' standards
Abstract

Objectives: To determine whether antibiotic prescribing can be reduced in nursing homes using a quality improvement (QI) program that involves providers, staff, residents, and families., Design: A 9-month quasi-experimental trial of a QI program in 12 nursing homes (6 comparison, 6 intervention) conducted from March to November 2011., Setting: Nursing homes in two regions of North Carolina, roughly half of whose residents received care from a single practice of long-term care providers., Participants: All residents, including 1,497 who were prescribed antibiotics., Intervention: In the intervention sites, providers in the single practice and nursing home nurses received training related to prescribing guidelines, including situations for which antibiotics are generally not indicated, and nursing home residents and their families were sensitized to matters related to antibiotic prescribing. Feedback on prescribing was shared with providers and nursing home staff monthly., Measurements: Rates of antibiotic prescribing for presumed urinary tract, skin and soft tissue, and respiratory infections., Results: The QI program reduced the number of prescriptions ordered between baseline and follow-up more in intervention than in comparison nursing homes (adjusted incidence rate ratio = 0.86, 95% confidence interval = 0.79-0.95). Based on baseline prescribing rates of 12.95 prescriptions per 1,000 resident-days, this estimated adjusted incidence rate ratio implies 1.8 prescriptions avoided per 1,000 resident-days., Conclusion: This magnitude of effect is unusual in efforts to reduce antibiotic use in nursing homes. Outcomes could be attributed to the commitment of the providers; outreach to providers and staff; and a focus on common clinical situations in which antibiotics are generally not indicated; and suggest that similar results can be achieved on a wider scale if similar commitment is obtained and education provided., (© 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.)

Published
2014
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4. Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update

Author

Saiman, Lisa, Siegel, Jane D., LiPuma, John J., Brown, Rebekah F., Bryson, Elizabeth A., Chambers, Mary Jo, Downer, Veronica S., Fliege, Jill, Hazle, Leslie A., Jain, Manu, Marshall, Bruce C., O’Malley, Catherine, Pattee, Suzanne R., Potter-Bynoe, Gail, Reid, Siobhan, Robinson, Karen A., Sabadosa, Kathryn A., Schmidt, H. Joel, Tullis, Elizabeth, Webber, Jennifer, and Weber, David J.

Published
2014
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46. A 2‐Year Pragmatic Trial of Antibiotic Stewardship in 27 Community Nursing Homes.

Author

Sloane, Philip D., Zimmerman, Sheryl, Ward, Kimberly, Kistler, Christine E., Paone, Deborah, Weber, David J., Wretman, Christopher J., and Preisser, John S.

Subjects
ANTIBIOTICS, NURSE prescribing, NURSING care facilities, COMMUNITY health nursing, MEDICAL personnel, ANTI-infective agents, CLOSTRIDIUM diseases, COMMUNITY health services, COMPARATIVE studies, CONFIDENCE intervals, DRUG utilization, HOSPITAL care, INFECTION, MEDICAL protocols, MEDICAL prescriptions, QUALITY assurance, STAPHYLOCOCCAL diseases, THERAPEUTICS, TIME, URINALYSIS, COST analysis, RANDOMIZED controlled trials, HUMAN services programs, PATIENT readmissions, METHICILLIN-resistant staphylococcus aureus, EVALUATION of human services programs, DESCRIPTIVE statistics, HOSPITAL nursing staff, ODDS ratio
Abstract

OBJECTIVES: To determine if antibiotic prescribing in community nursing homes (NHs) can be reduced by a multicomponent antibiotic stewardship intervention implemented by medical providers and nursing staff and whether implementation is more effective if performed by a NH chain or a medical provider group. DESIGN: Two‐year quality improvement pragmatic implementation trial with two arms (NH chain and medical provider group). SETTING: A total of 27 community NHs in North Carolina that are typical of NHs statewide, conducted before announcement of the US Centers for Medicare and Medicaid Services antibiotic stewardship mandate. PARTICIPANTS: Nursing staff and medical care providers in the participating NHs. INTERVENTION: Standardized antibiotic stewardship quality improvement program, including training modules for nurses and medical providers, posters, algorithms, communication guidelines, quarterly information briefs, an annual quality improvement report, an informational brochure for residents and families, and free continuing education credit. MEASUREMENTS: Antibiotic prescribing rates per 1000 resident days overall and by infection type; rate of urine test ordering; and incidence of Clostridium difficile and methicillin‐resistant Staphylococcus aureus (MRSA) infections. RESULTS: Systemic antibiotic prescription rates decreased from baseline by 18% at 12 months (incident rate ratio [IRR] = 0.82; 95% confidence interval [CI] = 0.69‐0.98) and 23% at 24 months (IRR = 0.77; 95% CI = 0.65‐0.90). A 10% increase in the proportion of residents with the medical director as primary physician was associated with a 4% reduction in prescribing (IRR = 0.96; 95% CI = 0.92‐0.99). Incidence of C. difficile and MRSA infections, hospitalizations, and hospital readmissions did not change significantly. No adverse events from antibiotic nonprescription were reported. Estimated 2‐year implementation costs per NH, exclusive of medical provider time, ranged from $354 to $3653. CONCLUSIONS: Antibiotic stewardship programs can be successfully disseminated in community NHs through either NH administration or medical provider groups and can achieve significant reductions in antibiotic use for at least 2 years. Medical director involvement is an important element of program success. J Am Geriatr Soc 68:46–54, 2019 See related editorial by Furuno et al. in this issue. [ABSTRACT FROM AUTHOR]

Published
2020
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49. Bacillus Species

Author

Weber, David J. and Rutala, William A.

Published
1988

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