Methods: A 43-question survey instrument based on the Donabedian structure, process, outcome framework was developed by the study investigators and administered electronically using REDCap. Wisconsin NHs were invited to complete the survey via a Division of Quality Assurance listserve. Two follow-up requests were sent in order to enhance response rates. Data were collected from February to May of 2015.
Results: 170 of the 388 (44%) Wisconsin NHs completed the survey instrument. 87% of the respondents reported having an antibiotic monitoring/stewardship program (ASP) although the program was only formally recognized in half of NHs. ASP team meetings were commonly integrated into other facility quality improvement meetings and were usually multi-disciplinary. A majority of participating NHs monitored antibiotic starts (98.5%). Measurement of antibiotic duration (44%), utilization of specific antibiotic classes (29%) and provider-specific utilization (23%) was less common. Education was a common improvement strategy employed (81%) but primarily targeted RNs (99%) rather than families (59%) or prescribers (42%). Audit of antibiotic appropriateness (87%) with feedback to prescribers (59%) was another commonly employed improvement strategy. A minority of NHs reported use of NH-specific antibiotic prescribing guidelines (37%), antibiograms (9%), antibiotic formularies (7%) and antibiotic pre-authorization (6%).Prescriber resistance was a commonly reported barrier to antibiotic stewardship in study NHs (58%).
Conclusion: A suprisingly high level of basic antibiotic stewardship activity is present in many Wisconsin NHs. Whether these findings are unique to Wisconsin or mirror an underlying national trend requires further validation. Our findings suggest that a substantial number of Wisconsin NHs are capable of implementing antibiotic improvement interventions though prescriber resistance represents an ongoing challenge.
T. C. Van Schooneveld, None
P. Smith, None
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