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ABSTRACT. Objective: This paper describes and examines the implementation of a quality improvement (QI) program to reduce potentially inappropriate antibiotic prescribing in residential care/assisted living (RC/AL) and nursing homes (NHs) in the context of organizational performance. Methods: A QI program that included evidence-based medical provider training related to prescribing, use of a standardized form to communicate signs and symptoms of infection, resident and family education, and ongoing monitoring and feedback and monthly QI meetings, was implemented in four RC/AL settings and six NHs in North Carolina. Program fidelity was assessed during monthly team meetings and by medical record review, and facilitators and barriers to implementation were identified by interviews with medical providers and staff. Results were considered in light of both setting types operating as complex adaptive systems. Results: It was challenging to train the numerous medical providers in RC/AL settings, but markedly easier to train the NH providers, who championed the QI program. On the other hand, evidence of change in staff practices was more evident in RC/AL, but staff in both settings were receptive to learning the signs and symptoms of infection that need to be communicated to better inform antibiotic prescribing. Conclusion: Change in antibiotic prescribing in RC/AL and NHs can be achieved through better informed and increased communication between long-term care staff and medical providers. By implementing the same QI program in both RC/AL and NH settings, the centrality of the role of the health care supervisor in RC/AL, and the need for medical provider endorsement in NHs, became clear. Consequently, efforts to change prescribing must be tailored according to the setting. pp. 41–52

Keywords: nursing homes; assisted living; residential care; long-term care; quality improvement; antibiotic resistance

How to cite: Zimmerman, Sheryl, C. Madeline Mitchell, Anna Song Beeber, Christine Kistler, David Reed, Latarsha Chisholm, Rosanna Bertrand, and Philip D. Sloane (2015), "Strategies to Reduce Potentially Inappropriate Antibiotic Prescribing in Assisted Living and Nursing Homes and Inform Other Quality Improvement Efforts," American Journal of Medical Research 2(1): 41–52.

SHERYL ZIMMERMAN
This email address is being protected from spambots. You need JavaScript enabled to view it.
C. MADELINE MITCHELL, ANNA SONG BEEBER,
CHRISTINE KISTLER, DAVID REED,
LATARSHA CHISHOLM, ROSANNA BERTRAND,
PHILIP D. SLOANE
University of North Carolina at Chapel Hill

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