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

Abstract

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.

Factors that influence the implementation of innovation in aged care: a scoping review

“…Of the 2530 retrieved studies, 193 were ultimately included 6,7,11–201 . The PRISMA-ScR diagram (Figure 1) shows the study selection process and reasons for full-text exclusion.…”

Implementation of an intervention to reduce urine dipstick testing in aged care homes: a qualitative study of enablers and barriers, and strategies to enhance delivery

“…We have described an AMS intervention targeted at nursing and personal care staff. A recent systematic review reports that interventions to improve prescribing in aged care typically target physicians and nursing staff,27 with interventions targeting nurses and personal carers less commonly reported 17 28. A Danish study introducing education sessions and reflection and communication tools for nurses and nursing assistants reported positive qualitative (staff behaviour change in performing clinical assessments)17 and quantitative (reduced antibiotic prescribing for UTI) outcomes 28.…”

“…Interview guides (online supplemental files 1 and 2) were informed by the TDF domains13 and literature reviews 10 16–18. Overall content was not restricted by TDF to allow for the emergence of unanticipated topics during the interviews 19.…”

Nursing home nurses' opinions on the potential evolution of their role in antibiotic stewardship: A French national cross‐sectional survey

“…In case a positive impact is demonstrated, training and guidelines must be available, for example to improve asymptomatic bacteriuria management (Gahr et al., 2007), and reduce overtesting of residents for urine samples (Crnich et al., 2015). A Danish study suggested that a combination of educational activities and support tools can help nursing home nurses implement more evidence‐based practices regarding antibiotics for urinary tract infections in nursing homes (Kousgaard et al., 2022).…”

“…(Crnich et al, 2015). A Danish study suggested that a combination of educational activities and support tools can help nursing home nurses implement more evidence-based practices regarding antibiotics for urinary tract infections in nursing homes (Kousgaard et al, 2022).…”