Assignment: Benchmark-Antibiotic Stewardship
Assignment: Benchmark-Antibiotic Stewardship
In this assignment, students will pull together the capstone project components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. At the conclusion of this project, the student will be able to apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.
Students will develop a 1,250-1,500 written project that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:
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Background
Problem statement
Purpose of the change proposal
PICOT
Literature search strategy employed
Evaluation of the literature
Applicable change or nursing theory utilized
Proposed implementation plan with outcome measures
Identification of potential barriers to plan implementation, and a discussion of how these could be overcome
Appendix section, if tables, graphs, surveys, educational materials, etc. are created
Review the feedback from your instructor on the Topic 3 assignment, PICOT Statement Paper, and Topic 6 assignment, Literature Review. Use the feedback to make appropriate revisions to the portfolio components before submitting.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
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Benchmark-Antibiotic Stewardship
Antibiotics are drugs prescribed to prevent and treat bacterial infections. Antibiotic resistance develops when the target bacteria changes in response to the use of these drugs. As a result, the bacteria become antibiotic-resistant. The purpose of this assignment is to discuss the problem of antimicrobial resistance, my change proposal, literature findings, and the implementation plan based on my PICOT statement.
Background
Antibiotic resistance has led to an increasing number of infections, including tuberculosis, pneumonia, salmonellosis, and gonorrhea, which have become more difficult to treat since antibiotics have become less effective. Antibiotic resistance is associated with overuse resulting in more complicated infections, prolonged hospital stays, increased demand for healthcare, high medical costs, and increased morbidity and mortality rates (Chardavoyne & Kasmire, 2020). For instance, when infections cannot be treated using first-line antibiotics, more costly drugs must be used. Besides, it results in a longer duration of disease and treatment, increasing health care costs and the economic burden on families and the community.
Problem Statement
Antibiotic resistance is one of the biggest threats to the global health and development of healthcare systems today. Although it can occur naturally, misuse of antibiotics in treating human beings and animals has accelerated the process. In areas where antibiotics are available for purchase for human or animal use without a prescription, the emergence and spread of resistance worsen (Chardavoyne & Kasmire, 2020). Likewise, in countries without standard treatment guidelines, antibiotics are usually over-prescribed by healthcare providers and veterinarians and over-used by the public, resulting in resistance. Antibiotic resistance puts the achievements of modern medicine at risk since advanced treatment procedures become life-threatening without effective antibiotics to prevent and treat infections (Chardavoyne & Kasmire, 2020). If urgent interventions are not implemented, we might head to a post-antibiotic era, whereby common infections and minor injuries can easily cause mortalities.
Purpose Of The Change Proposal
The proposed change is to prescribe organism-specific antibiotics to older adults with UTI and antibiotic resistance in long-term care facilities rather than using broad-spectrum antibiotics. The proposal aims to enhance patient safety by reducing the incidence of antibiotic resistance. Besides, the proposal seeks to promote a practice where broad-spectrum antibiotics are only be prescribed when waiting for culture results and then changed to organism-specific antibiotics (Chardavoyne & Kasmire, 2020). Tailoring antibiotics to the specific bacteria will decrease antibiotic resistance in UTIs, prevent adverse effects, reduce healthcare costs, and increase patient satisfaction by avoiding unnecessary treatments.
PICOT
The PICOT question for the identified problem is: How effective are broad-spectrum antibiotics compared to organism-specific antibiotics in older adults presenting with a urinary tract infection (UTI) and antibiotic resistance in long-term care facilities?
Literature Search Strategy Employed
To identify literature articles on antibiotic resistance, I used research databases such as PubMed, Cochrane Database of Systematic Reviews, UpToDate, and MEDLINE. The databases helped to source peer-reviewed articles related to the topic of interest. I entered keywords from the PICOT to simplify the search, including ‘broad-spectrum antibiotics’ ‘organism-specific antibiotics’ ‘urinary tract infection’ and ‘antibiotic resistance. In addition, I limited the search to articles published in English from January 2017 to August 2021 to ensure the articles are up-to-date.
Evaluation Of The Literature
Brown et al. (2019) evaluated a program tailored to improve diagnosis and management of UTIs in long-term care. Implementation of the UTI program led to a decrease in urine culturing and antibiotic use. We can conclude that implementing syndrome-specific interventions that target prescribing for UTI is effective since it reduces urine culturing and antibiotic prescribing (Brown et al., 2019). A similar program can be implemented in long-term care facilities to lower antibiotic resistance among geriatric patients with UTIs.
Carter et al. (2018) examined the attitude of nurses and infection preventionists toward five nurse-driven antibiotic stewardship practices. The practices were: Probing on the need for urine cultures; Ensuring appropriate culturing technique; Documenting an accurate penicillin drug allergy history; Encouraging timely transition from intravenous to oral antibiotics; Initiating an antibiotic timeout (Carter et al., 2018). The study identified the following practices as most favorable: Probing the need for urinary cultures; Collecting cultures using appropriate collection techniques, and initiating the shift from IV to PO antibiotics. Active participation by nurses in these practices is likely to help optimize antibiotic use. Studies have demonstrated that inappropriate urine culturing practices result in preventable and prolonged antibiotic treatment. Besides, a prompt switch from IV to PO antibiotics decreases the duration of IV antibiotics and inpatient hospital stays, thus reducing healthcare costs.
Nicolle (2014) examined the current evidence assessing the efficacy of antimicrobial stewardship interventions in long-term care facilities. The antimicrobial stewardship interventions included education, development of guidelines, providing feedback to practitioners, and consultation on infectious disease. The study established that interventions that focused on specific aspects of UTI treatment, including limiting treatment of asymptomatic bacteriuria or prophylaxis of urinary infection, were effective (Nicolle, 2014). It is this crucial that providers address the widespread use of long-term prophylaxis for UTIs to reduce antimicrobial resistance.
Applicable Change Or Nursing Theory Utilized
The nursing theory utilized for the proposal is Salmon White’s Construct for Public Health Nursing. Salmon White described public health as a structured societal effort to protect, promote and restore individuals’ health and public health nursing to focus on achieving and maintaining public health (Bergeron et al., 2017). The theory’s priorities include prevention of disease and ill health, protection against disease and external agents, and health promotion (Bergeron et al., 2017). Nursing interventions to achieve the priorities include: Education aimed at voluntary change in the attitude and behavior of the subjects; Engineering aimed at managing risk-related variables; Enforcement aimed at mandatory regulation to attain better health. Education can be implemented to change the attitude and behavior of providers towards appropriate prescribing and reducing antimicrobial resistance (Bergeron et al., 2017). Engineering can be used to alter the environment in a way that protects patients against resistance. Lastly, enforcement can be used to put interventions to reduce antimicrobial resistance into place.
Proposed Implementation Plan With Outcome Measures
Implementing the plan on prescribing organism-specific antibiotics to older adults with UTI and antibiotic resistance in long-term care facilities will begin with training healthcare providers. The training will comprise causes of antimicrobial resistance, risk factors, the scope of the problem, impact, prevention, and control. They will also be trained on the clinical guidelines on the treatment of UTIs in geriatrics. After training, a pilot trial will be conducted in some units where nosocomial UTIs are rampant. Health providers will be asked to report cases of antimicrobial resistance in these units and give feedback on how the practice can be improved to achieve the desired outcome. After a successful pilot trial, the intervention will be implemented in the entire facility. The proposed interventions from the feedback will be incorporated in the final implementation phase. In addition, the incidence of antimicrobial resistance will be compared pre-and post-intervention to evaluate the program’s efficacy.
Potential Barriers To Plan Implementation
Barriers in the implementation may include clinician’s misconceptions, resistance from providers; Patient demand and expectations; and Influence of drug reps. Clinicians may have misconceptions about when broad-spectrum antibiotics should be prescribed (Saliba-Gustafsson et al., 2021). The misconceptions may result in resistance from providers on adhering to the practice of prescribing organism-specific antibiotics. These may be addressed by training the clinicians on safe prescribing and the impact of the practice in reducing resistance. Patients often have demands and expectations of being prescribed broad antibiotics, and clinicians feel obliged to meet these demands (Saliba-Gustafsson et al., 2021). The barrier can be addressed by educating patients on the treatment plan, including options available for their diagnosis. Drug reps often expose clinicians to information that can negatively impact their quality of antibiotic prescribing resulting in irrational prescriptions. The barrier can be addressed by organizing regular CMEs to disseminate scientifically sound and evidence-informed guidelines.
Conclusion
The incidence of antimicrobial resistance is increasing to dangerously high levels worldwide. New resistance mechanisms are rising and spreading globally, threatening the ability to treat common infectious diseases. The resistant bacteria often cause infections, which become more challenging to treat than infections caused by non-resistant bacteria. My proposal entails prescribing organism-specific antibiotics to older adults with UTI and antibiotic resistance in long-term care facilities. The proposal seeks to reduce antimicrobial resistance, improve health outcomes, and reduce healthcare costs. Literature reveals that employing specific interventions that target prescribing for UTI reduces urine culturing and antibiotic prescribing.
References
Bergeron, K., Abdi, S., DeCorby, K., Mensah, G., Rempel, B., & Manson, H. (2017). Theories, models, and frameworks used in capacity building interventions relevant to public health: a systematic review. BMC public health, 17(1), 1-12. https://doi.org/10.1186/s12889-017-4919-y
Brown, K. A., Chambers, A., MacFarlane, S., Langford, B., Leung, V., Quirk, J., Schwartz, K. L., & Garber, G. (2019). Reducing unnecessary urine culturing and antibiotic overprescribing in long-term care: a before-and-after analysis. CMAJ Open, 7(1), E174–E181. https://doi.org/10.9778/cmajo.20180064
Carter, E. J., Greendyke, W. G., Furuya, E. Y., Srinivasan, A., Shelley, A. N., Bothra, A., Saiman, L., & Larson, E. L. (2018). Exploring the nurses’ role in antibiotic stewardship: A multisite qualitative study of nurses and infection preventionists. American journal of infection control, 46(5), 492–497. https://doi.org/10.1016/j.ajic.2017.12.016
Chardavoyne, P. C., & Kasmire, K. E. (2020). Appropriateness of Antibiotic Prescriptions for Urinary Tract Infections. The western journal of emergency medicine, 21(3), 633–639. https://doi.org/10.5811/westjem.2020.1.45944
Nicolle, L. E. (2014). Antimicrobial stewardship in long-term care facilities: what is effective?. Antimicrobial resistance and infection control, 3(1), 1-7. https://doi.org/10.1186/2047-2994-3-6
Saliba-Gustafsson, E. A., Nyberg, A., Borg, M. A., Rosales-Klintz, S., & Stålsby Lundborg, C. (2021). Barriers and facilitators to prudent antibiotic prescribing for acute respiratory tract infections: A qualitative study with general practitioners in Malta. PloS one, 16(2), e0246782. https://doi.org/10.1371/journal.pone.0246782
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