How will we improve antibiotic prescribing in nursing homes?

PRE-Prescribing Process  POST-Prescribing Process Patient Change in Condition -> Initial Antibiotic Therapy Decision -> Therapy Modification Decision

This study aims to improve antibiotic prescribing in nursing homes by facilitating \ antibiotic decision-making. Improvements target two decisions: the initial antibiotic decision before an antibiotic is prescribed, and a subsequent review of the antibiotic order after the antibiotic is prescribed. Each decision is made of processes and tasks. The intervention implemented in this study aids and supports nursing home staff as they complete these processes and tasks when an antibiotic is prescribed.

In the pre-prescribing process, the intervention focuses on standardizing assessment of the resident Change in condition, assigning infection risk to the patient, facilitating communication of assessment with prescribers, and guiding prescribers through initial antibiotic prescribing decisions.

In the post-prescribing process, the intervention focuses on communicating initiation of antibiotic therapy with the Primary Care Provider (PCP), reassessing the resident, determining eligibility for a change in antibiotic therapy, communicating findings of the updated information to the prescriber, and guiding prescribers through antibiotic modification decisions.

In this study, we use a systems redesign approach to study nursing homes and the antibiotic prescribing process. A systems approach helps us to understand antibiotic prescribing as it takes place in individual nursing homes, recognizing that each nursing home is unique. This allows a tailored approach to improving the quality of antibiotic prescribing, rather than treating all nursing homes as a “one size fits all.”

The intervention in this study is implemented using a Quality Improvement Collaborative (QIC) process, a facilitated implementation that includes coaching facilities both individually and in groups. The QIC implementation takes about three months, and is followed by a six-month sustainability period to determine how sustainable the intervention is.