scholarly journals Antimicrobial stewardship programmes in nursing homes: a systematic review and inventory of tools

2020 ◽  
Vol 75 (6) ◽  
pp. 1390-1397
Author(s):  
Martin Belan ◽  
Nathalie Thilly ◽  
Céline Pulcini
Keyword(s):  
Systematic Review ◽  
Nursing Homes ◽  
Antimicrobial Stewardship ◽  
Outcome Measurement ◽  
Antibiotic Use ◽  
The Internet ◽  
Home Setting ◽  
Microbiological Testing ◽  
Nursing Home Setting ◽  
Multifaceted Interventions

Abstract Background Antimicrobial overuse/misuse is common in nursing homes and although the effectiveness of antimicrobial stewardship (AMS) programmes has been well explored and demonstrated in hospitals, data are scarce for the nursing-home setting. Our objectives for this systematic review were to make an inventory of: (i) all interventions that could be considered as part of AMS programmes in nursing homes; and (ii) all stewardship tools and guidance that are freely available. Methods We performed a systematic review using the MEDLINE database from inception to June 2018, including all interventional studies, reviews, opinion pieces and guidelines/guidance exploring AMS programmes in nursing homes. For the inventory of freely available tools and guidance to help implement an AMS programme, we also performed screening of professional societies and official agencies’ websites and a questionnaire survey among a panel of international experts. Results A total of 36 articles were included in our systematic review. Most interventions took place in North America and have explored education or persuasive interventions within multifaceted interventions, showing that they can improve guideline adherence and decrease antibiotic use and unnecessary microbiological testing. Most reviews also highlighted the importance of accountability, monitoring and feedback. A large number of tools (156) available for free on the internet were identified, mostly about education, patient assessment and outcome measurement. Conclusions Although high-quality interventional studies are lacking, multifaceted interventions including education, monitoring and feedback seem the most promising strategy. Many tools are available on the internet and can be used to help implement AMS programmes in nursing homes.

scholarly journals Status of Antimicrobial Stewardship Implementation in Some Egyptian Hospitals, a Cross-sectional Study

2021 ◽  
Author(s):  
Noha Alaa Hamdy ◽  
Nahla Hesham Kandil ◽  
Ahmed Noby Amer
Keyword(s):  
Antimicrobial Stewardship ◽  
Outcome Measurement ◽  
Action Plan ◽  
Antibiotic Use ◽  
Cross Sectional Study ◽  
Future Application ◽  
Sectional Study ◽  
Cross Sectional ◽  
It Support ◽  
Restriction Methods

Abstract Background: Antimicrobial stewardship (ASP) aims to stopping or slowing emergence of antimicrobial resistant strains. After initiation of National action plan on antimicrobial resistance (AMR) in Egypt, there were several initiatives by hospitals to implement ASP but no formal assessment was performed.Objective & setting: This study attempts to assess the extent of ASP application in different Egyptian hospitals; stewardship knowledge & implementation in selected hospitals. Method: A cross-sectional study was conducted to assess stewardship knowledge & implementation in selected hospitals in Egypt. Main outcome measure: Core elements of the survey included Hospital Description, ASP committee, ASP Activities (including training, restriction methods and outcome measurement), reporting antibiotic use, antibiogram, information technology (IT) support, ASP restriction methods and ASP Future ApplicationResults: The study included many aspects regarding hospital description; all types of hospitals were involved. Most of hospitals (61.8%) implemented an ASP program while 38.2% did not; 71.4 % of the later are planning for future Antimicrobial stewardship application. 22 hospitals (48.5%) reported having facility-specific antibiogram on regular basis. 13 hospitals (37.1%) reported receiving antimicrobial reports on regular basis. 15 hospitals (42.9%) reported having one or more computer programs already in use. The monitoring activities included resistance patterns, infection rates, length of stay, mortality rate & reported adverse drug reactions. Only 20% of the hospitals included in this study reported having an ASP training program. Conclusion: Egyptian hospitals have a fairly good implementation, improvements need to include IT support programs, healthcare members cooperation, monitoring outcomes & infectious disease (ID) consultations.

scholarly journals Evaluating and prioritizing antimicrobial stewardship programs for nursing homes: A modified Delphi panel

2020 ◽  
Vol 41 (9) ◽  
pp. 1028-1034
Author(s):  
Shaul Z. Kruger ◽  
Susan E. Bronskill ◽  
Lianne Jeffs ◽  
Marilyn Steinberg ◽  
Andrew M. Morris ◽  
...  
Keyword(s):  
Nursing Home ◽  
Antimicrobial Resistance ◽  
Nursing Homes ◽  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Educational Interventions ◽  
Audit And Feedback ◽  
Delphi Panel ◽  
Scientific Merit ◽  
Modified Delphi

AbstractBackground:Antibiotic use in nursing homes is often inappropriate, in terms of overuse and misuse, and it can be linked to adverse events and antimicrobial resistance. Antimicrobial stewardship programs (ASPs) can optimize antibiotic use by minimizing unnecessary prescriptions, treatment cost, and the overall spread of antimicrobial resistance. Nursing home providers and residents are candidates for ASP implementation, yet guidelines for implementation are limited.Objective:To support nursing home providers with the selection and adoption of ASP interventions.Design and Setting:A multiphase modified Delphi method to assess 15 ASP interventions across criteria addressing scientific merit, feasibility, impact, accountability, and importance. This study included surveys supplemented with a 1-day consensus meeting.Participants:A 16-member multidisciplinary panel of experts and resident representatives.Results:From highest to lowest, 6 interventions were prioritized by the panel: (1) guidelines for empiric prescribing, (2) audit and feedback, (3) communication tools, (4) short-course antibiotic therapy, (5) scheduled antibiotic reassessment, and (6) clinical decision support systems. Several interventions were not endorsed: antibiograms, educational interventions, formulary review, and automatic substitution. A lack of nursing home resources was noted, which could impede multifaceted interventions.Conclusions:Nursing home providers should consider 6 key interventions for ASPs. Such interventions may be feasible for nursing home settings and impactful for improving antibiotic use; however, scientific merit supporting each is variable. A multifaceted approach may be necessary for long-term improvement but difficult to implement.

scholarly journals The Impact of Isolation on Healthcare Worker Contact and Compliance With Infection Control Practices in Nursing Homes

2018 ◽  
Vol 39 (6) ◽  
pp. 683-687 ◽  
Author(s):  
Lisa Pineles ◽  
Chris Petruccelli ◽  
Eli N. Perencevich ◽  
Mary-Claire Roghmann ◽  
Kalpana Gupta ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Hand Hygiene ◽  
Healthcare Worker ◽  
Healthcare Workers ◽  
Home Setting ◽  
Prevention Behavior ◽  
Nursing Home Setting ◽  
Hygiene Compliance ◽  
The Impact

OBJECTIVETo directly observe healthcare workers in a nursing home setting to measure frequency and duration of resident contact and infection prevention behavior as a factor of isolation practiceDESIGNObservational studySETTING AND PARTICIPANTSHealthcare workers in 8 VA nursing homes in Florida, Maryland, Massachusetts, Michigan, Washington, and TexasMETHODSOver a 15-month period, trained research staff without clinical responsibilities on the units observed nursing home resident room activity for 15–30-minute intervals. Observers recorded time of entry and exit, isolation status, visitor type (staff, visitor, etc), hand hygiene, use of gloves and gowns, and activities performed in the room when visible.RESULTSA total of 999 hours of observation were conducted across 8 VA nursing homes during which 4,325 visits were observed. Residents in isolation received an average of 4.73 visits per hour of observation compared with 4.21 for nonisolation residents (P<.01), a 12.4% increase in visits for residents in isolation. Residents in isolation received an average of 3.53 resident care activities per hour of observation, compared with 2.46 for residents not in isolation (P<.01). For residents in isolation, compliance was 34% for gowns and 58% for gloves. Healthcare worker hand hygiene compliance was 45% versus 44% (P=.79) on entry and 66% versus 55% (P<.01) on exit for isolation and nonisolation rooms, respectively.CONCLUSIONSHealthcare workers visited residents in isolation more frequently, likely because they required greater assistance. Compliance with gowns and gloves for isolation was limited in the nursing home setting. Adherence to hand hygiene also was less than optimal, regardless of isolation status of residents.Infect Control Hosp Epidemiol 2018;39:683–687

A Systematic Review of Malnutrition Screening Tools for the Nursing Home Setting

2014 ◽  
Vol 15 (3) ◽  
pp. 171-184 ◽  
Author(s):  
Marian A.E. van Bokhorst–de van der Schueren ◽  
Patrícia Realino Guaitoli ◽  
Elise P. Jansma ◽  
Henrica C.W. de Vet
Keyword(s):  
Systematic Review ◽  
Nursing Home ◽  
Screening Tools ◽  
Home Setting ◽  
Nursing Home Setting

scholarly journals DESCRIBING A CONCEPT OF NURSE INTUITION AND IMPLICATIONS FOR DEMENTIA CARE IN NURSING HOMES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S838-S838 ◽  
Author(s):  
Rebekah Perkins ◽  
Katherine Supiano’katherine supiano@hsc utah edu’ kather
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Psychological Symptoms ◽  
Empirical Studies ◽  
Dementia Care ◽  
Limited Information ◽  
Mentor Programs ◽  
Home Setting ◽  
Nurse Residency ◽  
Nursing Home Setting

Abstract The purpose of this concept analysis was to explore nurse intuition historically and in current literature, appraise the value of nurse intuition to research and practice, and discuss implications for practice in caring for residents with behavioral and psychological symptoms of Dementia (BPSD) in nursing homes. To date, no research has examined the presence or utility of nurse intuition in the nursing home setting. A conceptual analysis using pragmatic utility was chosen and based on the work of Walker and Avant (2005). In the literature, nurse intuition is characterized by attributes of knowledge not preceded by inference, knowledge that is holistic in nature, independent of linear thinking, and drawn from synthesis instead of analysis. Nurse intuition is based on preconditions of experience, empathy, limited information, and limited time to make vital decisions about patient care. Studies on nurse intuition have been criticized for their lack of rigor and empirical evidence of the effect of nurse intuition on positive patient outcomes. The attributes of intuitive nursing practice have important implications in nursing applied to residents with BPSD. The nursing home nurse with extensive educational and experiential knowledge is well-situated to understand the complex, changing needs of residents exhibiting various forms of BPSD in an effort to communicate their needs. Future studies on nurse intuition should focus on early education in dementia care, nurse residency-mentor programs to enhance intuitive thinking in the management of BPSD, and more empirical studies on the use of intuition in the context of dementia care.

scholarly journals Recreational Therapy in Nursing Homes: History, Regulations, COVID-19, and Beyond

2021 ◽  
Vol 55 (1) ◽  
Author(s):  
Tarah Loy ◽  
Dawn DeVries ◽  
M. Jean Keller
Keyword(s):  
Older Adults ◽  
Nursing Homes ◽  
Health Professionals ◽  
Recreational Therapy ◽  
Allied Health Professionals ◽  
Home Setting ◽  
Nursing Home Setting ◽  
History Of ◽  
The Impact ◽  
Future Practice

The current pandemic has changed the way allied health professionals, including recreational therapists, provide care in the nursing home setting. This article aims to address concerns for older adults residing in nursing homes by reviewing the history of nursing homes, analyzing the impact regulations have had on the recreational therapy profession, and offering considerations for future practice in a COVID-19 world.

Interventions to improve antibiotic prescribing at hospital discharge: A systematic review

2020 ◽  
Vol 42 (1) ◽  
pp. 96-99 ◽  
Author(s):  
Lindsay M. Daniels ◽  
David J. Weber
Keyword(s):  
Systematic Review ◽  
Hospital Discharge ◽  
Antimicrobial Stewardship ◽  
Unmet Need ◽  
Antibiotic Use ◽  
Antibiotic Prescribing

AbstractA large proportion of antibiotic use associated with hospitalization occurs immediately after discharge, representing an important focus for antimicrobial stewardship programs. This review identified few studies evaluating the effect of interventions aimed at improving discharge antibiotic prescribing. Antimicrobial stewardship to improve postdischarge antibiotic prescribing is an unmet need warranting further study.

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