Abstract Presentations Impact of Educational Intervention on Total Antimicrobial Use AMU and Appropriateness of Antibiotic Prescription for Urinary Tract Infection UTI in Long Term Care Facilities LTCF ID: 930990
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AMMI Canada-CACMID Annual Conference 2020 Online Oral and Poster Abstract Presentations
Impact of Educational Intervention on Total Antimicrobial Use (AMU) and Appropriateness of Antibiotic Prescription for Urinary Tract Infection (UTI) in Long Term Care Facilities (LTCF)Vicki Doyle RN1, Michelle Whittle RN1, Claire Pratt BSc2, Zahra Rehan BSc2, Carla Penney MSc2, Ashley Waghmare BSc3, Peter Daley MD MSc FRCPC DTM+H4 June 12,2020 The Impact
Eastern Health Region. 2. Memorial University. 3. Lawton’s Pharmacy
4. Medicine and Laboratory Medicine, Memorial University
Slide2Conflict of Interest/DisclosureNo conflict of interests to declare
Slide3Antimicrobial Stewardship in LTCFHigh antimicrobial use rate
High rate of treatment of ASB (asymptomatic bacteriuria)Testing and treatment decisions weighted to nurse practitioners and nursesPrivate facilities, private pharmacy may not benefit from regional AMS committee involvement
Slide4Antimicrobial Utilization and Suitability in Long-term Care Facilities: A Retrospective Cross-sectional Study. Carla Penney, Sarah Boyd, Amanda Mansfield, Janice Dalton, Judy O'Keefe, Peter Daley. Journal of the Association of Medical Microbiology and Infectious Diseases Canada 2018 doi:10.3138/jammi.2018-0021
10 LTCF in St. John’s, NL3,148 prescriptions for 1,313 residents 2.40 prescriptions/ patient/yearMedian duration 7 days21.16 Defined Daily Doses/1,000 patient-days500 randomly selected prescriptions assessed by Loeb 2001 criteria259/448 (57.8%) of prescriptions were inappropriate115/163 (70.5%) given for urinary tract infection 78/140 (55.7%) given for lower respiratory tract infection15/68 (22.0%) given for skin and soft-tissue infection
Slide5Slide6Research Question
Population: 15 LTC facilities in St. John’s, NLIntervention: Nursing education Control: NoneOutcome: AMUAppropriateness of treatment with UTI antibiotics in 1 LTCF Design: Before and after quasi-experimental
Slide7Intervention
On site nursing education regarding urinary tract infection in LTCF in 201715 LTCF, 352 nurses, 52 sessionsAlgorithm for urine culture collectionHydration for patients not meeting criteria for UTIAppropriate treatment recommendations
Slide8Methods
AMUAnnual prescriptions receivedDDD/1000 pt daysAppropriateness1 LTCF selectedAll 79 prescriptions for UTI antibiotics in 2018 reviewed retrospectivelyLoeb 2001 criteriaHappe 2017 criteria
Slide9LTCF Total AMU
Slide10LTCF Prescriptions by Drug Category
Slide11Appropriateness of UTI Treatment
Improvement 2018 compared to 2015 of +26.9% (p=0.001) using the Loeb 2001 criteria
Slide12Discussion/ConclusionsAMU rate in LTCF is high, with long durationEducation improved appropriateness of UTI treatment significantly
Education did not impact overall AMU
Slide13Future InterventionsRCT’s show interventions reduce use by 14%, without worsening outcomesEducation alone not enoughPossible interventions
Audit and FeedbackRestrict durationEducate familiesWu et al. Antimicrobial Stewardship Programs in Long‐Term Care Settings: A Meta‐Analysis and Systematic Review. J Amer Ger Soc 2018Davey et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Review 2017
Slide14AcknowledgementsNurse practitioners in LTC