Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
J Am Geriatr Soc. 2014 May;62(5):907-12. doi: 10.1111/jgs.12784. Epub 2014 Apr 2.
To determine whether antibiotic prescribing can be reduced in nursing homes using a quality improvement (QI) program that involves providers, staff, residents, and families.
A 9-month quasi-experimental trial of a QI program in 12 nursing homes (6 comparison, 6 intervention) conducted from March to November 2011.
Nursing homes in two regions of North Carolina, roughly half of whose residents received care from a single practice of long-term care providers.
All residents, including 1,497 who were prescribed antibiotics.
In the intervention sites, providers in the single practice and nursing home nurses received training related to prescribing guidelines, including situations for which antibiotics are generally not indicated, and nursing home residents and their families were sensitized to matters related to antibiotic prescribing. Feedback on prescribing was shared with providers and nursing home staff monthly.
Rates of antibiotic prescribing for presumed urinary tract, skin and soft tissue, and respiratory infections.
The QI program reduced the number of prescriptions ordered between baseline and follow-up more in intervention than in comparison nursing homes (adjusted incidence rate ratio = 0.86, 95% confidence interval = 0.79-0.95). Based on baseline prescribing rates of 12.95 prescriptions per 1,000 resident-days, this estimated adjusted incidence rate ratio implies 1.8 prescriptions avoided per 1,000 resident-days.
This magnitude of effect is unusual in efforts to reduce antibiotic use in nursing homes. Outcomes could be attributed to the commitment of the providers; outreach to providers and staff; and a focus on common clinical situations in which antibiotics are generally not indicated; and suggest that similar results can be achieved on a wider scale if similar commitment is obtained and education provided.
通过一项涉及提供者、员工、居民和家属的质量改进（QI）计划，确定在养老院中是否可以减少抗生素的使用。
2011 年 3 月至 11 月期间，对 12 家养老院（6 家对照，6 家干预）进行的为期 9 个月的 QI 计划的准实验性试验。
北卡罗来纳州两个地区的养老院，其居民约有一半接受来自单一长期护理提供者实践的护理。
所有居民，包括 1497 名接受抗生素治疗的居民。
在干预地点，单一实践中的提供者和养老院护士接受了与处方指南相关的培训，包括一般不表明使用抗生素的情况，并使养老院居民及其家属对与抗生素处方相关的事项敏感。每月与提供者和养老院工作人员分享有关处方的反馈。
假定尿路感染、皮肤和软组织以及呼吸道感染的抗生素处方率。
QI 计划在干预和对照养老院之间，在基线和随访之间减少了处方数量（调整发病率比=0.86，95%置信区间=0.79-0.95）。根据基线处方率为每 1000 名居民-天 12.95 张处方，这一估计的调整发病率比意味着每 1000 名居民-天避免 1.8 张处方。
在减少养老院抗生素使用方面，这种效果的幅度是不寻常的。结果可以归因于提供者的承诺；向提供者和工作人员提供帮助；并关注通常不需要抗生素的常见临床情况；并表明，如果获得类似的承诺并提供教育，在更广泛的范围内可以实现类似的结果。
