Pilot study of a multifaceted nurse-led antimicrobial stewardship intervention in residential aged care

Abstract

ObjectiveTo evaluate the feasibility of a nurse-led antimicrobial stewardship (AMS) program in two Australian residential aged care homes (RACHs) to inform a stepped-wedged, cluster randomised controlled trial (SW-cRCT).MethodsA mixed-methods pilot study of a nurse-led AMS program was performed in two RACHs in Victoria, Australia between July and December 2019. The AMS program comprised education, infection assessment and management guidelines, and documentation to support appropriate antimicrobial use in urinary, lower respiratory and skin/soft tissue infections. The program was implemented over three phases over five months: 1) pre-implementation education and integration (1-month); 2) implementation of the intervention (3-months); 3) post-intervention evaluation (1-month). Baseline RACH and resident data and weekly infection and antimicrobial usage was collected. Feedback on intervention resources and implementation barriers were identified from semi-structured interviews, online staff questionnaire and researcher field notes.ResultsSix key barriers to implementation of the intervention were identified and used to refine the intervention; aged care staffing and capacity, access to education, resistance to practice change, role of staff in AMS, leadership and ownership of the intervention at the RACH and organisation-level, and expectations from family. A total 61 antimicrobials were prescribed for 40 residents over the 3-month intervention period. Overall, 48% of antibiotics did not meet the minimum criteria for appropriate initiation (respiratory 73%; urinary: 54%; skin/soft tissue: 0%).ConclusionsSeveral barriers and opportunities to improve the implementation of AMS in RACHs were identified. Findings were used to inform a revised intervention to be evaluated in a larger SW-cRCT.