Improvements in Antibiotic Appropriateness for Cystitis in Older Nursing Home Residents: A Quality Improvement Study With Randomized Assignment.
Joseph T Hanlon, Subashan Perera, Steven Schweon and 3 others
PMID 32948472WHAT IT FOUND
A webinar, pocket cards, and order sets did not show a clear reduction in inappropriate antibiotics for nursing home cystitis (0.13 versus 0.21 per 1000 resident days).
Duration problems were less common, but more drug-interaction problems occurred. The components cannot be separated.
Key findings
01The rate of potentially inappropriate antibiotics was not significantly lower in intervention homes (0.13 versus 0.21 per 1000 resident days; adjusted incident rate ratio 0.79; 95% CI 0.45 to 1.38).
02The intervention had less inappropriate antibiotic duration than control, but more drug-drug interaction problems (8% versus 1%).
03Quinolones were the most common inappropriately prescribed antibiotic class, and penicillin use was lower in intervention homes.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study included only 167 cases, and the appropriateness outcome was secondary, so it may not have enough power to detect a real difference. A single geriatric clinical pharmacist rated all cases; another clinician might not agree as readily, and typical long-term care pharmacists may need training to use the index. The intervention had three components, and the study did not show which component mattered. Physicians may have cared for residents in both intervention and control homes, although geographic separation was used to reduce this. Physicians may have received other antibiotic stewardship education outside the study. The homes came from some US regions, so results may not apply everywhere.
The easy way to misread this
Do not conclude that this educational bundle significantly improved antibiotic appropriateness. The overall inappropriate antibiotic rate was 0.13 versus 0.21 per 1000 resident days, with an adjusted incident rate ratio of 0.79 and a 95% confidence interval of 0.45 to 1.38, so the difference was not statistically significant.