1890. Process Evaluation of the Guide to Nursing Home Antimicrobial Stewardship
Session: Poster Abstract Session: Antibiotic Stewardship: Long Term Care
Saturday, October 29, 2016
Room: Poster Hall
  • IDWeek_2016_Final.pdf (544.5 kB)
  • Background:  Nursing home residents have high rates of infection and associated antibiotic use, which makes infection control a vital patient-safety and quality-improvement concern. Overexposure to antibiotics allows drug resistant strains of bacteria and health care associated infections to emerge. When this occurs, it is harder to treat infections, and residents may develop complications from using antibiotics needed to treat resistant organisms. The result is increased resident mortality, hospitalizations, and costs. We developed and tested a Guide to Nursing Home Antimicrobial Stewardship (the Guide) based in part on the results of four previous AHRQ-supported research studies of antibiotic stewardship in nursing homes. The Guide is intended to help nursing homes understand antimicrobial stewardship, start a program, and implement evidence-based strategies to improve antibiotic use.

    Methods:  To test the effectiveness of the Guide, we conducted a pre-post analysis, with no control group, in nine nursing homes for six months pre-intervention and six months post-intervention. Process evaluation data were derived from pre-, post-, and interim interviews with nursing home staff using semi-structured protocols to determine the fidelity of Guide implementation.

    Results:  Nursing home leaders want to engage in stewardship. Leaders and staff viewed the tools positively overall, indicating that they have the right information, and are well-designed and easy to learn. Some staff believed the Guide’s tools had helped them improve patient care. Facilitators included strong leadership; training; adequate staffing and resources; and integration of stewardship into other quality goals. Implementation challenges included fitting tools into existing work flow practices; overcoming incorrect beliefs about urinary tract infections, coordinating paper-based tools with EHRs; sustaining consistent use, e.g, through staff turnover; and overcoming staff resistance to tools that were perceived to be “more work.”

    Conclusion: The Guide provides useful tools that help nursing homes address specific antimicrobial stewardship goals. Implementation requires effort because work habits are being changed, but challenges presented are manageable.

    Elizabeth Frentzel, MPH1, Rikki Mangrum, MLS1, Tamika Cowans, MPP2, Mona Kilany, PhD1, Darcy Mcmaughan, PhD3, Dia Barber, BSPH1, Denise Mitchell, BA1, Deborah Perfetto, PharmD4 and Jing Guo, Ph.D.5, (1)American Institutes for Research, Chapel Hill, NC, (2)American Institutes for Research, Washington, DC, (3)Texas A&M Health Science Center, College Station, TX, (4)Agency for Healthcare Research and Quality, Rockville, MD, (5)American Institutes for Research, Rockville, MD


    E. Frentzel, None

    R. Mangrum, None

    T. Cowans, None

    M. Kilany, None

    D. Mcmaughan, None

    D. Barber, None

    D. Mitchell, None

    D. Perfetto, None

    J. Guo, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.