Antimicrobial Stewardship in Long-Term Care Facilities: Focus on Suspected UTI

Resistance to antibiotics used in the treatment of bacterial infections is increasing globally. Residents of long-term care facilities (LTCFs) are at risk for resistant infections and are especially vulnerable. In many LTCFs decisions to prescribe antibiotics are often made by an off-site provider and influenced by limited laboratory results and communication from LTCF staff. Clinicians often prescribe broad-spectrum agents to cover for potential pathogens, without a clear clinical picture on which to base the decision. This potentiates antimicrobial misuse, regarding the frequency and appropriateness of antibiotic initiation. Each year, most long-term care facility residents are prescribed antibiotics, for which urinary tract infection (UTI) is the most common diagnosis, however many of the antibiotics prescribed are unnecessary or inappropriate. Improved knowledge of antimicrobial resistance and stewardship strategies has the potential to impact the global health problem of antimicrobial resistance. Although there are existing guidelines and consensus criteria to guide clinical decision making, they have been relatively underused by healthcare providers.

An eLearning module about UTI specific antimicrobial stewardship in long-term care facilities was developed for nurse practitioners practicing in this setting. The aim of this quantitative quasi-experimental study was to investigate the results of this eLearning module and whether it would increase the knowledge of nurse practitioners about antimicrobial stewardship. The test results of a pre-test and a post-test were compared. The results of this study show a positive effect of the eLearning module on the knowledge of the nurse practitioners.

The link for the eLearning module entitled “Antimicrobial Stewardship in Long-Term Care Facilities: Focus on Suspected UTI”, with links to the pretest and posttest, was sent out to 50 nurse practitioners. Ten (20%) of the nurse practitioners consented to participate in the study and completed the pretest, eLearning module, and posttest. A difference was observed between the number of correct answers on the pretest (M = 6.4, SD = 1.35) and the number of correct answers on the post-test (M = 8.1, SD = 1.197). A paired sample t-test was conducted to compare the number of correct pretest responses with the number of correct post-test responses and calculates p = 0.006. Based on the results, since the p < 0.05, the null hypothesis is rejected. Therefore, a significant difference was determined by the researcher, thus supporting the clinical question. Antimicrobial stewardship education via the eLearning module does increase knowledge of nurse practitioners in long-term care settings.

The researcher has concluded that this eLearning module has shown a significant increase of knowledge of nurse practitioners in the long-term care setting, thereby empowering them to utilize this information and antimicrobial stewardship strategies to improve the safety and quality of care of elderly long-term care facility residents. Nurse practitioners play an important role in antimicrobial stewardship through their roles as clinician, educator and through use of evidence-based practice and translational research. Focused antimicrobial stewardship strategies including surveillance, criteria for antimicrobial initiation, and SBAR communication would likely improve the burden of antimicrobial resistance in LTCFs.