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

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.

Moving behavioral interventions in nursing homes from planning to action: a work system evaluation of a urinary tract infection toolkit implementation

“…External influences and competing demands stretched NH staff to their limits, making it difficult to successfully rollout the UTI toolkit within NHs. This is consistent with the literature which suggest that addressing daily clinical needs (i.e., “fires”) impacts implementation and hinders sustainability [ 47 ].…”

“…Ongoing and consistent education on the UTI toolkit is a critical component to sustain antibiotic stewardship programs [ 47 , 48 ]. NH champions in our study addressed ongoing educational efforts by incorporating the trainings related to the UTI toolkit into new staff orientation meetings and by continuously allowing opportunities in monthly staffing meetings to discuss the UTI toolkit and the associated implementation efforts.…”

Pragmatic Trials in Long-Term Care: Research Challenges and Potential Solutions in Relation to Key Areas of Care

“…47 Active participation of a champion and stakeholder team was consistently mentioned as essential to successful implementation and sustainability. 46,48,49 Care initiatives that are perceived as beneficial to staff and residents are also more likely to be sustained by staff providing the care. 50e52 The use of technology was repeatedly encouraged to facilitate scalability of interventions and approaches.…”

Pragmatic Trials in Long‐Term Care: Research Challenges and Potential Solutions in Relation to Key Areas of Care

“…47 Active participation of a champion and stakeholder team was consistently mentioned as essential to successful implementation and sustainability. 46,48,49 Care initiatives that are perceived as beneficial to staff and residents are also more likely to be sustained by staff providing the care. [50][51][52] The use of technology was repeatedly encouraged to facilitate scalability of interventions and approaches.…”

“…Feasible interventions are those that are integrated into the care plan or part of ongoing care processes, 7,46 aligned with policy, or important to the setting based on relevant organizational, patient‐centered, and/or regional/national goals 47 . Active participation of a champion and stakeholder team was consistently mentioned as essential to successful implementation and sustainability 46,48,49 . Care initiatives that are perceived as beneficial to staff and residents are also more likely to be sustained by staff providing the care 50–52 …”