Hostname: page-component-848d4c4894-x5gtn Total loading time: 0 Render date: 2024-06-01T19:23:48.364Z Has data issue: false hasContentIssue false
  • English
  • Français

“There is no one to pick up the pieces”: Sustainability of antibiotic stewardship programs in nursing homes

Published online by Cambridge University Press:  26 October 2020

Sandhya Seshadri Open the ORCID record for Sandhya Seshadri [Opens in a new window] ,
Christina B. Felsen ,
Craig R. Sellers  and
Ghinwa K. Dumyati
Sandhya Seshadri*
Affiliation:
School of Nursing and Department of Neurology, University of Rochester, Rochester, New York
Christina B. Felsen
Affiliation:
Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, New York
Craig R. Sellers
Affiliation:
School of Nursing and Department of Medicine, Geriatrics and Aging, University of Rochester, Rochester, New York
Ghinwa K. Dumyati
Affiliation:
Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, New York Infectious Diseases Division, University of Rochester Medical Center, Rochester, New York
*
Author for correspondence: Sandhya Seshadri, E-mail: sandhya_seshadri@urmc.rochester.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To describe nursing home staff experiences and perceptions of the factors that impact the sustainability of an antibiotic stewardship program (ASP).

Methods:

Using a qualitative descriptive design, semistructured interviews with staff at 9 not-for-profit nursing homes with an established ASP were conducted and audio recorded. De-identified transcriptions of the interviews were coded using a sustainability framework and were analyzed to identify themes.

Results:

Interviews were conducted with 48 clinical and administrative staff to elicit their perceptions of the ASPs, and 7 themes were identified. ASPs were perceived to be resource intensive and “data driven,” requiring access to and interpretation of data that are not readily available at many nursing homes. Though motivated and committed, ASP champions felt that they could not single-handedly sustain the program. Attending to daily clinical needs (ie, “fires”) made it hard to progress beyond implementation and to reach step 2 of sustainability. Longstanding treatment habits by external prescribers and regulations were believed to impede ASP efforts. Partnerships with an external consultant with antibiotic stewardship expertise were considered important, as was the need for internal leadership support and collaboration across disciplinary boundaries. Participants felt that consistent and ongoing education on antibiotic stewardship at all staff levels was important.

Conclusions:

Although many interconnected factors impact the sustainability of an ASP, nursing homes may be able to sustain an ASP by focusing on 3 critical areas: (1) explicit support by nursing home leadership, (2) external partnerships with professionals with antibiotic stewardship expertise and internal interprofessional collaborations, and (3) consistent education and training for all staff.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 4 , April 2021 , pp. 440 - 447
Check for updates
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Benoit, SR, Nsa, W, Richards, CL, et al. Factors associated with antimicrobial use in nursing homes: a multilevel model. J Am Geriatr Soc 2008;56:2039–2044.CrossRefGoogle ScholarPubMed
Wu, JH, Langford, BJ, Daneman, N, Friedrich, JO, Garber, G. Antimicrobial stewardship programs in long-term care settings: a meta-analysis and systematic review. J Am Geriatr Soc 2019;67:392–399.CrossRefGoogle ScholarPubMed
Nicolle, LE, Bentley, DW, Garibaldi, R, Neuhaus, EG, Smith, PW; SHEA Long-Term-Care Committee. Antimicrobial use in long-term-care facilities. Infect Control Hosp Epidemiol 2000;21:537–545.CrossRefGoogle ScholarPubMed
Rotjanapan, P, Dosa, D, Thomas, KS. Potentially inappropriate treatment of urinary tract infections in two Rhode Island nursing homes. Arch Intern Med 2011;171:438–443.CrossRefGoogle ScholarPubMed
Sloane, PD, Kistler, CE, Reed, D, Weber, DJ, Ward, K, Zimmerman, S. Urine culture testing in community nursing homes: gateway to antibiotic overprescribing. Infect Control Hosp Epidemiol 2017;38:524–531.CrossRefGoogle ScholarPubMed
Sloane, PD, Huslage, K, Kistler, CE, Zimmerman, S. Optimizing antibiotic use in nursing homes through antibiotic stewardship. NC Med J 2016;77:324–329.Google ScholarPubMed
The core elements of antibiotic stewardship for nursing homes. Centers for Disease Control and Prevention website. http://www.cdc.gov/longtermcare/index.html. Published 2015. Accessed August 13, 2018.Google Scholar
Felsen, CB, Dodds Ashley, ES, Barney, GR, et al. Reducing fluoroquinolone use and Clostridioides difficile infections in community nursing homes through hospital–nursing home collaboration. J Am Med Dir Assoc 2020;21:55–61.CrossRefGoogle ScholarPubMed
Shelton, RC, Cooper, BR, Stirman, SW. The sustainability of evidence-based interventions and practices in public health and health care. Annu Rev Public Health 2018;39:55–76.Google ScholarPubMed
Sandelowski, M. What’s in a name? Qualitative description revisited. Res Nurs Health 2010;33:77–84.Google Scholar
Atlas.ti [computer program]. Berlin, Germany: Scientific Software Development GmbH; 2020.Google Scholar
Lorencatto, F, Charani, E, Sevdalis, N, Tarrant, C, Davey, P. Driving sustainable change in antimicrobial prescribing practice: how can social and behavioural sciences help? J Antimicrob Chemother 2018;73:2613–2624.CrossRefGoogle ScholarPubMed
Szymczak, JE. Are surgeons different? the case for bespoke antimicrobial stewardship. Clin Infect Dis 2019;69:21–23.CrossRefGoogle ScholarPubMed
Carter, RR, Montpetite, MM, Jump, RLP. Mixed-methods pilot study to assess perceptions of antimicrobial stewardship in nursing homes. J Am Geriatr Soc 2017;65:1073–1078.CrossRefGoogle ScholarPubMed
Chambers, A, MacFarlane, S, Zvonar, R, et al. A recipe for antimicrobial stewardship success: using intervention mapping to develop a program to reduce antibiotic overuse in long-term care. Infect Control Hosp Epidemiol 2019;40:24–31.CrossRefGoogle ScholarPubMed
Charani, E, Holmes, A. Antibiotic stewardship–twenty years in the making. Antibiotics (Basel) 2019;8:7.CrossRefGoogle Scholar
Fleming, A, Bradley, C, Cullinan, S, Byrne, S. Antibiotic prescribing in long-term care facilities: a meta-synthesis of qualitative research. Drugs Aging 2015;32:295–303.CrossRefGoogle ScholarPubMed
Jump, RLP, Crnich, CJ, Mody, L, Bradley, SF, Nicolle, LE, Yoshikawa, TT. Infectious diseases in older adults of long-term care facilities: update on approach to diagnosis and management. J Am Geriatr Soc 2018;66:789–803.Google ScholarPubMed
Katz, MJ, Gurses, AP, Tamma, PD, Cosgrove, SE, Miller, MA, Jump, RLP. Implementing antimicrobial stewardship in long-term care settings: an integrative review using a human factors approach. Clin Infect Dis 2017;65:1943–1951.CrossRefGoogle ScholarPubMed
Collier, E, Harrington, C. Staffing characteristics, turnover rates, and quality of resident care in nursing facilities. Res Gerontol Nurs 2008;1:157–170.CrossRefGoogle ScholarPubMed
Crnich, CJ, Jump, R, Trautner, B, Sloane, PD, Mody, L. Optimizing antibiotic stewardship in nursing homes: a narrative review and recommendations for improvement. Drugs Aging 2015;32:699–716.CrossRefGoogle ScholarPubMed
Pakyz, AL, Moczygemba, LR, VanderWielen, LM, Edmond, MB, Stevens, MP, Kuzel, AJ. Facilitators and barriers to implementing antimicrobial stewardship strategies: results from a qualitative study. Am J Infect Control 2014;42:S257–S263.CrossRefGoogle ScholarPubMed
Stone, PW, Herzig, CTA, Agarwal, M, Pogorzelska-Maziarz, M, Dick, AW. Nursing home infection control program characteristics, CMS citations, and implementation of antibiotic stewardship policies: a national study. Inquiry 2018;55:46958018778636.Google ScholarPubMed
Fleming, A, Bradley, C, Cullinan, S, Byrne, S. Antibiotic prescribing in long-term care facilities: a qualitative, multidisciplinary investigation. BMJ Open 2014;4:e006442.Google Scholar
Morrill, HJ, Caffrey, AR, Jump, RLP, Dosa, D, LaPlante, KL. Antimicrobial stewardship in long-term care facilities: a call to action. J Am Med Dir Assoc 2016;17:183.Google ScholarPubMed
Sloane, PD, Zimmerman, S, Ward, K, et al. A 2-year pragmatic trial of antibiotic stewardship in 27 community nursing homes. J Am Geriatr Soc 2019;68:46–54.CrossRefGoogle ScholarPubMed
McElligott, M, Welham, G, Pop-Vicas, A, Taylor, L, Crnich, CJ. Antibiotic stewardship in nursing facilities. Infect Dis Clin North Am 2017;31:619–638.CrossRefGoogle ScholarPubMed
Nace, DA, Drinka, PJ, Crnich, CJ. Clinical uncertainties in the approach to long-term care residents with possible urinary tract infection. J Am Med Dir Assoc 2014;15:133–139.CrossRefGoogle ScholarPubMed
Kohut, MR, Keller, SC, Linder, JA, et al. The inconvincible patient: how clinicians perceive demand for antibiotics in the outpatient setting. Fam Pract 2020;37:276–282.Google ScholarPubMed
Kullar, R, Yang, H, Grein, J, Murthy, R. A roadmap to implementing antimicrobial stewardship principles in long-term care facilities (LTCFs): collaboration between an acute-care hospital and LTCFs. Clin Infect Dis 2018;66:1304–1312.Google ScholarPubMed
Giuliano, CA, Binienda, J, Kale-Pradhan, PB, Fakih, MG. “I never would have caught that before”: pharmacist perceptions of using clinical decision support for antimicrobial stewardship in the United States. Qual Health Res 2018;28:745–755.Google ScholarPubMed
Fu, CJ, Mantell, E, Stone, PW, Agarwal, M. Characteristics of nursing homes with comprehensive antibiotic stewardship programs: results of a national survey. Am J Infect Control 2020;48:13–18.CrossRefGoogle ScholarPubMed
Bremmer, DN, Trienski, TL, Walsh, TL, Moffa, MA. Role of technology in antimicrobial stewardship. Med Clin N Am 2018;102:955–963.CrossRefGoogle ScholarPubMed
Manning, ML, Pogorzelska-Maziarz, M. Health care system leaders’ perspectives on infection preventionist and registered nurse engagement in antibiotic stewardship. Am J Infect Control 2018;46:498–502.Google ScholarPubMed
Broom, A, Broom, J, Kirby, E, Plage, S, Adams, J. What role do pharmacists play in mediating antibiotic use in hospitals? a qualitative study. BMJ Open 2015;5.5(11):e008326.CrossRefGoogle Scholar