Mixed-Methods Pilot Study to Assess Perceptions of Antimicrobial Stewardship in Nursing Homes.
OBJECTIVE
To identify features of community nursing home (NH) environments associated with lower rates of overall antibiotic use.


METHODS
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 NHs.


METHODS
NHs.


METHODS
Clinical leadership of five NHs.


METHODS
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 NHs. For the qualitative phase, semistructured interviews were conducted with healthcare workers in leadership positions at five community NHs. 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 NHs 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 NHs reported pressure from well-intentioned family members to prescribe antibiotics. NHs with shorter lengths of therapy and lower overall antibiotic use were consonant with an environment more supportive of antimicrobial stewardship.


CONCLUSIONS
These findings suggest several features of NHs that are supportive of antimicrobial stewardship: practice patterns grounded in established diagnostic criteria, proactive infection control and prevention, open communication and interconnectedness among staff.
Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio.
Rebecca R
RR
Carter
Interprofessional Improvement Research, Education and Clinical Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio.
Michelle M
MM
Montpetite
Geriatric Research Education and Clinical Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio.|Center of Innovation, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio.|Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University, Cleveland, Ohio.
Robin L P
RLP
Jump
D000890:Anti-Infective Agents / Q000627:therapeutic use; D003141:Communicable Diseases / Q000188:drug therapy; D024841:Fluoroquinolones / Q000627:therapeutic use; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control / Q000523:psychology*; D017053:Infection Control / Q000379:methods*; D009735:Nursing Homes; D010865:Pilot Projects; D010818:Practice Patterns, Physicians'
D000890:Anti-Infective Agents; D024841:Fluoroquinolones
antimicrobial stewardship; fluoroquinolones; infectious diseases; nursing home; semistructured interview