Journal article
Pilot study to evaluate the need and implementation of a multifaceted nurse-led antimicrobial stewardship intervention in residential aged care
- Abstract:
-
Objectives
To evaluate the need and feasibility of a nurse-led antimicrobial stewardship (AMS) programme in two Australian residential aged care homes (RACHs) to inform a stepped-wedged, cluster randomized controlled trial (SW-cRCT).
Methods
A mixed-methods pilot study of a nurse-led AMS programme was performed in two RACHs in Victoria, Australia (July-December 2019). The AMS programme comprised education, infection assessment and management guidelines, and documentation to support appropriate antimicrobial use in urinary, lower respiratory and skin/soft tissue infections. The programme was implemented over three phases: (i) pre-implementation education and integration (1 month); (ii) implementation of the intervention (3 months); and (iii) post-intervention evaluation (1 month). Baseline RACH and resident data and weekly infection and antimicrobial usage were collected and analysed descriptively to evaluate the need for AMS strategies. Feedback on intervention resources and implementation barriers were identified from semi-structured interviews, an online staff questionnaire and researcher field notes.
Results
Six 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 organization level; and family expectations. A total of 61 antimicrobials were prescribed for 40 residents over the 3 month intervention. Overall, 48% of antibiotics did not meet minimum criteria for appropriate initiation (respiratory: 73%; urinary: 54%; skin/soft tissue: 0%).
Conclusions
Several barriers and opportunities to improve implementation of AMS in RACHs were identified. Findings were used to inform a revised intervention to be evaluated in a larger SW-cRCT.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
Actions
Access Document
- Files:
-
-
(Preview, Supplementary materials, pdf, 350.0KB, Terms of use)
-
(Preview, Version of record, pdf, 165.0KB, Terms of use)
-
- Publisher copy:
- 10.1093/jacamr/dlae016
Authors
+ Australian Government
More from this funder
- Funder identifier:
- https://ror.org/0314h5y94
- Grant:
- GNT1152342
- Programme:
- Medical Research Future Fund
- Publisher:
- Oxford University Press
- Journal:
- JAC-Antimicrobial Resistance More from this journal
- Volume:
- 6
- Issue:
- 1
- Article number:
- dlae016
- Place of publication:
- England
- Publication date:
- 2024-02-14
- Acceptance date:
- 2024-01-12
- DOI:
- EISSN:
-
2632-1823
- Pmid:
-
38371999
- Language:
-
English
- Pubs id:
-
2091669
- Local pid:
-
pubs:2091669
- Deposit date:
-
2025-06-12
- ARK identifier:
Terms of use
- Copyright holder:
- Jokanovic et al.
- Copyright date:
- 2024
- Rights statement:
- © The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/ by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any me
- Licence:
- CC Attribution (CC BY)
If you are the owner of this record, you can report an update to it here: Report update to this record