263261 Reducing potentially inappropriate antibiotic prescribing in nursing homes

Tuesday, October 30, 2012 : 11:06 AM - 11:18 AM

Rosanna M. Bertrand, PhD , Domestic Health Division, Abt Associates Inc., Cambridge, MA
Lauren Olsho, PhD , Domestic Health Division, Abt Associates Inc., Cambridge, MA
Sheryl Zimmerman, PhD , School of Social Work, University of North Carolina, Chapel Hill, Chapel Hill, NC
Louise Hadden , Domestic Health Division, Abt Associates Inc., Cambridge, MA
Alrick Edwards, MPH , Domestic Health Division, Abt Associates Inc., Durham, NC
Philip Sloane, MD, MPH , Department of Family Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC
C. Madeline Mitchell, MURP , Cecil G. Sheps Center for Health Services Reserach, University of North Carolina, Chapel Hill, Chapel Hill, NC
Donna Hurd, MSN , Domestic Health Division, Abt Associates Inc., Cambridge, MA
As concern regarding antibiotic-resistant organisms has reached global proportions, attention has become focused on nursing homes (NH) where prescribing is high and often inappropriate. To examine the extent of potentially inappropriate antibiotic prescribing and the efficacy of educational efforts, we conducted and evaluated a quality improvement (QI) program in six North Carolina NHs. The program had four components: 1) training physicians in antibiotic prescribing criteria, specifically, the Loeb criteria; 2) training nurses in the use of a Medical Care Referral Form (MCRF) to report signs and symptoms of the Loeb criteria; 3) providing antibiotic information to residents, their families, and other NH staff; and 4) maintaining contact with physicians and NH staff during a six-month QI program. At baseline, monthly antibiotic prescriptions (unadjusted) ranged from 26-52 across the six NHs. Within three months of program initiation, five of the six settings evidenced reduced prescribing ranging from 19-41%. Adherence to the Loeb criteria increased for urinary tract infections (8% at baseline to 12% at follow-up), respiratory infections (2% at baseline to 8% at follow-up) and especially for skin infections (41% at baseline to 82% at follow-up). The MCRF was used to report information for only a minority of treated infections (from 0 to 17%). Antibiotic prescribing may be reduced in NHs through concerted efforts including prescriber training, focused staff-prescriber communication, and patient and family education. While not all treated infections should meet published criteria for appropriateness, further reduction in prescribing that does not meet criteria would likely constitute optimal care.

Learning Areas:
Administer health education strategies, interventions and programs

Learning Objectives:
Describe the public health concern related to over- and inappropriate antibiotic prescribing practices in nursing homes. Evaluate the effectiveness of a multi-facited program to reduce in appropriate prescibing practices in nursing homes. Demonstrate the validity of the use of the Loeb criteria for prescribing antibiotics

Keywords: Medicine, Quality Improvement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am Project Director for this and another federally-funded antibiotic intervention study, and was the technical lead on the team that conceptualized and submitted the winning proposals. I have overseen all aspects of the current study including the development of the training materials and the data collection tools. I also conducted physician and nurse surveys, supervised medical record and survey data entry, management, and analyses.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.