Factors Associated With Antimicrobial Use in Nursing Home Residents With Advanced Dementia.
Meghan Hendricksen, Daniel Habtemariam, Erika M C D'Agata and 1 others
PMID 32839124WHAT IT FOUND
Among 430 nursing home residents with advanced dementia, 52 received an antimicrobial course in two months.
Facilities with full-time nurse practitioners or physician assistants, fewer severely impaired residents, and less intense infection practices were linked to higher use.
Key findings
01A total of 52 residents received at least one antimicrobial course in the two months before the trial started.
02In the analysis that accounted for other factors, facilities with a full-time NP/PA on staff had a higher likelihood of antimicrobial use.
03In the same analysis, facilities with fewer residents at the most severe cognitive impairment level and lower infectious disease practice scores had a higher likelihood of antimicrobial use.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The facilities were only in the Boston area, so the results may not apply elsewhere. The analysis used baseline chart data and could not show that any facility factor caused antimicrobial use. Only 52 residents received antimicrobials, so the adjusted associations may be imprecise. The study reported any antimicrobial use in a two-month period, not person-time rates, so it is hard to compare with other studies. The authors did not have enough power to identify which infection-practice components mattered. Advance directives were not independently associated, contrary to some prior work, possibly because of limited power. The quality of provider-family discussions was not measured.
Declared interests
The trial was funded by the National Institutes of Health, and the authors declared no financial or conflicts of interest.
The easy way to misread this
Do not conclude that having a full-time NP/PA on staff causes more antibiotics. The study measured associations at baseline and did not show why this facility factor was linked to antimicrobial use.