School of Nursing, Duke University, Durham, North Carolina.
Cecil G. Sheps Center for Health Services Research, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina.
J Am Geriatr Soc. 2017 Jan;65(1):165-171. doi: 10.1111/jgs.14504. Epub 2016 Nov 7.
To examine perspectives on antibiotic use and antibiotic stewardship of nurses and medical providers in nursing homes (NHs).
Cross-sectional survey.
NHs in North Carolina (N = 31).
Nursing staff (n = 182) and medical providers (n = 50).
Respondents completed a self-administered questionnaire about their perspectives on antibiotic use in their NH, the influence of residents and families on antibiotic prescribing decisions, and readiness to improve antibiotic stewardship. Open-ended questions on barriers to antibiotic stewardship were also asked. Linear mixed modeling was used to analyze differences between respondent groups and to test for associations with individual and organizational characteristics.
All respondents supported reducing antibiotic use, although medical providers' support was significantly stronger (P = .005). When asked about their perception of residents' and family members' preference for antibiotic use in the case of suspected infection and the influence of that preference on antibiotic-prescribing decisions, respondents indicated that residents and families favor antibiotic use and influence prescribing decisions. Nurses reported a stronger perception than medical providers that families prefer antibiotics (P = .04) and influence prescribing decisions (P = .02). All respondents reported commitment and efficacy to change practices (mean 4.0-4.1 for nurses and 3.6-3.9 for medical providers on a 5-point scale). Four significant associations related to organizational and individual characteristics were found: directors of nursing and specialist nurses reported greater self-efficacy for changing practice than other nurses (P = .003), medical providers with a subspecialty (e.g., geriatrics) reported greater self-efficacy (P = .007) and commitment to change (P = .001) than those without a subspecialty, and medical providers specializing in hospice and palliative care rated family influence (P = .006) higher than those with other subspecialties.
Nursing staff and medical providers share a commitment to reducing unnecessary antibiotic use. Antibiotic stewardship interventions should foster cooperation and build competency to implement alternative management approaches and to educate residents and families. Nurse leaders and medical providers with long-term care training may be especially effective champions for antibiotic stewardship.
调查养老院（NHs）护士和医疗服务提供者对抗生素使用和抗生素管理的看法。
横断面调查。
北卡罗来纳州的 NHs（N=31）。
护理人员（n=182）和医疗服务提供者（n=50）。
受访者完成了一份关于他们对 NH 中抗生素使用的看法、居民和家庭对抗生素处方决策的影响以及改善抗生素管理的准备情况的自我管理问卷。还询问了对抗生素管理的障碍的开放性问题。线性混合模型用于分析受访者群体之间的差异，并测试与个人和组织特征的关联。
所有受访者都支持减少抗生素的使用，尽管医疗服务提供者的支持明显更强（P=0.005）。当被问及他们对疑似感染情况下居民和家庭成员对抗生素使用的偏好以及这种偏好对抗生素处方决策的影响时，受访者表示居民和家庭倾向于使用抗生素并影响处方决策。护士比医疗服务提供者更强烈地认为家庭更喜欢抗生素（P=0.04）并影响处方决策（P=0.02）。所有受访者都报告了改变实践的承诺和效力（护士的平均得分 4.0-4.1，医疗服务提供者的平均得分 3.6-3.9，均为 5 分制）。发现与组织和个人特征相关的四个显著关联：护理主任和专科护士比其他护士报告改变实践的自我效能更高（P=0.003），具有专科（如老年病学）的医疗服务提供者比没有专科的医疗服务提供者报告改变实践的自我效能（P=0.007）和承诺更高（P=0.001），专门从事临终关怀和姑息治疗的医疗服务提供者比其他专科的医疗服务提供者对家庭的影响评价更高（P=0.006）。
护理人员和医疗服务提供者都致力于减少不必要的抗生素使用。抗生素管理干预措施应促进合作，增强实施替代管理方法的能力，并对居民和家庭进行教育。具有长期护理培训的护士领导人和医疗服务提供者可能是抗生素管理的特别有效的倡导者。
