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Antibiotic Prescribing in 4 Assisted-Living Communities: Incidence and Potential for Improvement

Published online by Cambridge University Press:  10 May 2016

Philip D. Sloane ,
Sheryl Zimmerman ,
David Reed ,
Anna Song Beeber ,
Latarsha Chisholm ,
Christine Kistler ,
Christine Khandelwal ,
David J. Weber  and
C. Madeline Mitchell
Philip D. Sloane
Affiliation:
Department of Family Medicine, University of North Carolina at Chapel Hill, North Carolina Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, North Carolina
Sheryl Zimmerman
Affiliation:
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, North Carolina School of Social Work, University of North Carolina at Chapel Hill, North Carolina
David Reed
Affiliation:
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, North Carolina
Anna Song Beeber
Affiliation:
School of Nursing, University of North Carolina at Chapel Hill, North Carolina
Latarsha Chisholm
Affiliation:
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, North Carolina
Christine Kistler
Affiliation:
Department of Family Medicine, University of North Carolina at Chapel Hill, North Carolina
Christine Khandelwal
Affiliation:
Department of Family Medicine, University of North Carolina at Chapel Hill, North Carolina
David J. Weber
Affiliation:
Department of Medicine, University of North Carolina at Chapel Hill, North Carolina
C. Madeline Mitchell
Affiliation:
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, North Carolina
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Objective.

To describe the prevalence, characteristics, and appropriateness of systemic antibiotic use in assisted living (AL) and to conduct a preliminary quality improvement intervention trial to reduce inappropriate prescribing.

Design.

Pre-post study, with a 13-month intervention period.

Setting.

Four AL communities.

Participants.

All prescribers, all AL staff who communicate with prescribers, and all patients who had an infection during the baseline and intervention periods.

Intervention.

A standardized form for AL staff, an online education course and 5 practice briefs for prescribers, and monthly quality improvement meetings with AL staff.

Measurements.

Monthly inventory of all systemic antibiotic prescriptions; interviews with the prescriber, AL staff member, closest family member, and patient (when capable) regarding 85 antibiotic prescribing episodes (30 baseline, 55 intervention), with data review by an expert panel to determine prescribing appropriateness.

Results.

The mean number of systemic antibiotic prescriptions was 3.44 per 1,000 resident-days at baseline and 3.37 during the intervention, a nonsignificant change (P = .30). Few prescribers participated in online training. AL staff use of the standardized form gradually increased during the program. The proportion of prescriptions rated as probably inappropriate was 26% at baseline and 15% during the intervention, a nonsignificant trend (P = .25). Drug selection was largely appropriate during both time periods.

Conclusions.

AL antibiotic prescribing rates appear to be approximately one-half those seen in nursing homes, with up to a quarter being potentially inappropriate. Interventions to improve prescribing must reach all physicians and staff and most likely will require long time periods to have the optimal effect.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue S3: Preventing Healthcare–Associated Infections: Results and Lessons Learned from AHRQ's HAI Program , October 2014 , pp. S62 - S68
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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