Effect of an Educational Intervention on Optimizing Antibiotic Prescribing in Long‐Term Care Facilities

Abstract

An educational intervention combining an antibiotic guide and a prescribing profile was effective in decreasing nonadherent antibiotic prescriptions. Repetition of the intervention at regular intervals may be necessary to maintain its effectiveness.

Using Antibiograms to Improve Antibiotic Prescribing in Skilled Nursing Facilities

“…13 Although these were all well-designed and important studies, they are not directly comparable to our study. The studies included in the review primarily aimed to reduce antibiotic use or improve the proportion of prescribing that complied with guidelines developed by the investigators rather than to improve antibiotic prescribing using local antibiotic susceptibility data.…”

“…Incorporating the knowledge into common practice and changing the healthcare provider culture in SNFs is essential toward improving prescribing behavior and sustaining the effect of interventions over time. Of the previously described studies, only Monette et al 13 assessed whether the effects of the intervention persisted over time. Three to 6 months after the intervention, experimental facilities still had a higher frequency of antibiotic prescribing that adhered to the recommended guidelines compared with control facilities, but this effect was no longer statistically significant.…”

Influences on the start, selection and duration of treatment with antibiotics in long-term care facilities

“…In particular, peer comparison audit and feedback of prescriber profiles could be a pragmatic, effective and sustainable means of improving antimicrobial prescribing in long-term care on a broad scale. 17,22,25 Therefore, in this province-wide study of long-term care physicians we examined 3 prescribing tendencies for antibiotics that span the range of decision-making about antibiotics: tendency to start treatment with antibiotics, tendency to use antibiotics for prolonged periods and tendency to select a specific class of antibiotics. In the absence of any large-scale initiatives for antibiotic stewardship, we hypothesized that these 3 prescribing tendencies would vary across prescribers more than would be expected by chance or explained by resident characteristics, and that a clinician's historical prescribing tendency would strongly predict their current prescribing practice to patients.…”

“…12 Antibiotic stewardship interventions in long-term care have had promising but inconsistent effects on antibiotic use. [13][14][15] Prior initiatives have usually been multifaceted and have included educational sessions, [16][17][18][19][20][21] development of local guidelines, 16,17,[21][22][23] portable reference material, 16,19,23 on-site consultations about infectious diseases 24 or academic detailing. 18 Many of these interventions are labour intensive, and none have reported on cost-effectiveness or sustainability.…”

Antibiotic Prescribing in 4 Assisted-Living Communities: Incidence and Potential for Improvement

“…1 " A few studies of attempts to reduce ting would be important both because of the number of antibiotic overprescribing in nursing homes have been pubpersons served and because its organizational structure differs lished, and these have met with mixed results. 11 " 13 considerably from that of nursing homes, making extrapoDue to changes in long-term care regulation and financing, lation of results from nursing home studies not necessarily assisted living (AL) has grown in recent decades to rival nursappropriate to AL.ing homes in the number of chronically ill older persons To begin to understand the prevalence and characteristics served. 1415 Since nursing home and AL residents overlap conof antibiotic use in AL communities and to explore the po-…”