title: A quality improvement intervention to address provider behaviour as it relates to utilisation of CA-MRSA guidelines.
abstract: OBJECTIVE
  To evaluate the impact of a provider focused quality improvement educational intervention on appropriate prescribing for community associated methicillin-resistant Staphylococcus aureus infection.
  
  
  BACKGROUND
  Patient, provider and health system factors contribute to appropriate antibiotic prescription. Achieving appropriate prescribing is critical in decreasing the burden of antibiotic resistance. Knowledge of appropriate prescribing for community associated methicillin-resistant Staphylococcus aureus infection is the first step in shifting prescriber behaviour to evidence-based recommendations.
  
  
  METHODS
  Quality Improvement Project.
  
  
  METHODS
  Following a review of best practice guidelines and application of the Stetler Research Utilization model, a brief educational intervention was delivered using voice over PowerPoint. Items in the educational intervention included indications for screening, particularly focusing on the role of watch and wait after culturing for simple abscesses. The intervention was delivered in a for-profit, nonacademic, urgent care setting, and assessed prescribing providers' knowledge and practice.
  
  
  RESULTS
  Out of 48 medical doctor, physician assistant and nurse practitioner providers, 18 (37·5%) participated; 12 of the 18 (67%) participants showed an increase in knowledge. Forty three per cent of prescribers' charts demonstrated improved practice through use of the guidelines. Out of 18 prescribers, 44% sent a total of 21 cultures for abscesses. There was no difference in practice behaviours between professional groups.
  
  
  CONCLUSIONS
  In spite of the increase in knowledge scores, this improvement in knowledge did not translate in dramatic change in practice, although trends in a positive direction were noted.
  
  
  CONCLUSIONS
  This quality improvement project underscores the complexity of changing prescriber behaviour and the need for ongoing interventions.
authors.affiliation: School of Nursing, Johns Hopkins University, Baltimore, MD.
authors.forename: Roseann P
authors.initials: RP
authors.lastname: Velez
authors.forename: Kathleen Lent
authors.initials: KL
authors.lastname: Becker
authors.forename: Patricia
authors.initials: P
authors.lastname: Davidson
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Sloand
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019985:Benchmarking; D017714:Community-Acquired Infections; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards*; D058996:Quality Improvement; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: CA-MRSA; antimicrobial resistance; clinical guidelines; prescriber behaviour