Development of a Tailored, Complex Intervention for Clinical Reflection and Communication about Suspected Urinary Tract Infections in Nursing Home Residents

Arnold, Sif Helene; Olesen, Julie Aamand; Jensen, J. Steen; Bjerrum, Lars; Holm, Anne; Kousgaard, Marius Brostrøm

doi:10.3390/antibiotics9060360

Cited by 9 publications

(10 citation statements)

References 42 publications

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“…No data were provided to document the effect of these initiatives on antimicrobials consumption. Future ASP implementation will need to account of enablers (e.g., the presence of study leaders, skills training for doctors and nurses, and good inter-professional communication) and barriers (e.g., pressures from residents and families, NH staff’s knowledge and belief) in order to be successful, in addition to outcome data [ 12 , 52 ].…”

Section: Methodsmentioning

confidence: 99%

Interventions to optimize medication use in nursing homes: a narrative review

2021

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Purpose Polypharmacy, medication errors and adverse drug events are frequent among nursing home residents. Errors can occur at any step of the medication use process. We aimed to review interventions aiming at optimization of any step of medication use in nursing homes. Methods We narratively reviewed quantitative as well as qualitative studies, observational and experimental studies that described interventions, their effects as well as barriers and enablers to implementation. We prioritized recent studies with relevant findings for the European setting. Results Many interventions led to improvements in medication use. However, because of outcome heterogeneity, comparison between interventions was difficult. Prescribing was the most studied aspect of medication use. At the micro-level, medication review, multidisciplinary work, and more recently, patient-centered care components dominated. At the macro-level, guidelines and legislation, mainly for specific medication classes (e.g., antipsychotics) were employed. Utilization of technology also helped improve medication administration. Several barriers and enablers were reported, at individual, organizational, and system levels. Conclusion Overall, existing interventions are effective in optimizing medication use. However there is a need for further European well-designed and large-scale evaluations of under-researched intervention components (e.g., health information technology, patient-centered approaches), specific medication classes (e.g., antithrombotic agents), and interventions targeting medication use aspects other than prescribing (e.g., monitoring). Further development and uptake of core outcome sets is required. Finally, qualitative studies on barriers and enablers for intervention implementation would enable theory-driven intervention design.

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Section: Methodsmentioning

confidence: 99%

Interventions to optimize medication use in nursing homes: a narrative review

2021

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“…Likewise, in Sweden, which is known for a prudent use of antibiotics, the elderly population has a substantial higher use than the national target. To curb this higher use in the elderly population several Danish initiatives have been launched, for example, specific “nursing home doctors”, focus on increasing knowledge of infections and antibiotic treatments among nursing home staff [ 25 ] and improving diagnostic tools for UTIs in nursing homes [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Antibiotic prescribing in Danish general practice in the elderly population from 2010 to 2017

Jensen

Aabenhus

Holzknecht

et al. 2021

Scandinavian Journal of Primary Health Care

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Objective This study aimed to describe prescription of antibiotics to the elderly population in general practice in Denmark from 2010–2017. Design This is a national register-based observational study. Setting General practice, Denmark Main outcome measure The main outcome measure was prescriptions/1,000 inhabitants/day (PrID) in relation to year, age and sex, indication, and antibiotic agent. Subjects In this study, we included inhabitants of Denmark, ≥65 years of age between 01st July 2010–30th June 2017. Results A total of 5,168,878 prescriptions were included in the study. Antibiotic prescriptions decreased from 2.2 PrID to 1.7 (-26.9%, CI95% [-31.1;-22.4]) PrID during the study. The decrease in PrID was most noticeable among 65–74-year-olds (-25%). The ≥85-year-olds were exposed to twice as many PrID than the 65–74-year-olds, but only accounted for 20% of the total use. Urinary tract infection (UTI) was the most common indication for antibiotic prescription and increased with advancing age. The most commonly prescribed antibiotics were pivmecillinam and phenoxymethylpenicillin. Prescribing with no informative indication was present in one third of all cases. Conclusion The prescription of antibiotics in the elderly population in general practice decreased from 2010 to 2017. The oldest age group was exposed twice as frequently to antibiotic prescriptions as the 65–74-year-olds. The smallest reduction was observed for the ≥85-year-olds, suggesting targeting interventions at this group. Key Points High antibiotic use among elderly is well known and studies indicate mis- and overuse within this population. Our study shows. The prescription rate is decreasing within all age groups of the elderly population. The ≥85-year-olds receive twice as many prescriptions/1000/day as the 65–74-years-olds.

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“…In nursing homes, urinary tract infection (UTI) is the most common reason for antibiotic prescription but inappropriate prescriptions are frequent [ 2 , 4 , 5 ]. While several factors influence the prescribing process, two common misconceptions among healthcare staff seem to be of particular importance to the overuse of antibiotics in relation to suspected UTI in nursing home residents [ 6 , 7 ]. First, nonspecific behavioral symptoms in the elderly are often interpreted as signs of UTI [ 8 ] although guidelines do not recommend antibiotic treatment for such symptoms [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…This was the rationale of an intervention in Danish nursing homes which aimed at reducing prescriptions by providing knowledge and tools to support increased reflection among the nursing home staff and to support communication with general practice about suspected UTI [ 6 ]. The intervention was designed in a tailoring process and its effectiveness was tested in a cluster randomized controlled trial [ 6 , 7 , 17 ]. Since implementation of complex interventions is often difficult and since few implementation studies of interventions to reduce antibiotics use for suspected UTI have been conducted in nursing homes, we performed a qualitative study of the barriers and enablers to implementing the intervention in the nursing homes during the trial period.…”

Section: Introductionmentioning

confidence: 99%

“…Details concerning the rationale of the intervention, the development of the intervention, and the results from the effectiveness trial are reported elsewhere [ 6 , 7 , 17 ]. The intervention consisted of an introductory educational session and two paper-based tools to be used by the staff when they suspected UTI in a resident: a tool for observation and reflection (henceforth the reflection tool).…”

Section: Introductionmentioning

confidence: 99%

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Implementing an intervention to reduce use of antibiotics for suspected urinary tract infection in nursing homes – a qualitative study of barriers and enablers based on Normalization Process Theory

2022

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Background Overuse of antibiotics in the elderly population is contributing to the global health problem of antibiotic resistance. Hence, it is important to improve prescribing practices in care facilities for elderly residents. In nursing homes, urinary tract infection (UTI) is the most common reason for antibiotic prescription but inappropriate prescriptions are frequent. In order to reduce the use of antibiotics for suspected urinary tract infection in this context, a complex intervention based on education as well as tools for reflection and communication had been developed and trialed in a group of nursing homes. The presents study explored the barriers and enablers in implementing this complex intervention. Methods After the intervention trial period, a qualitative interview study was performed in six of the nursing homes that had received the intervention. The study included 12 informants: One senior manager, four nurses, six healthcare assistants, and one healthcare helper. Normalization Process Theory was used to structure the interviews as well as the analysis. Results The intervention was well received among the informants in terms of its purpose and content. The initial educational session had altered the informants’ perceptions of UTI and of the need for adopting a different approach to suspected UTIs. Also, the study participants generally experienced that the intervention had positively impacted their practice. The most important barrier was that some of the interventions’ clinical content was difficult to understand for the staff. This contributed to some problems with engaging all relevant staff in the intervention and with using the observation tool correctly in practice. Here, nurses played a key role in the implementation process by regularly explaining and discussing the intervention with other staff. Conclusion The results suggest that it is possible to implement more evidence-based practices concerning antibiotics use in nursing homes by employing a combination of educational activities and supportive tools directed at nursing home staff.

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Development of a Tailored, Complex Intervention for Clinical Reflection and Communication about Suspected Urinary Tract Infections in Nursing Home Residents

Cited by 9 publications

References 42 publications

Interventions to optimize medication use in nursing homes: a narrative review

Interventions to optimize medication use in nursing homes: a narrative review

Antibiotic prescribing in Danish general practice in the elderly population from 2010 to 2017

Implementing an intervention to reduce use of antibiotics for suspected urinary tract infection in nursing homes – a qualitative study of barriers and enablers based on Normalization Process Theory

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