Antimicrobial stewardship near the end of life in aged care homes

Leslie Dowson; N Deborah Friedman; Caroline Marshall; Rhonda L Stuart; Kirsty Buising; Arjun Rajkhowa; Fiona Gotterson; David C M Kong

doi:10.1016/j.ajic.2019.10.010

Antimicrobial stewardship near the end of life in aged care homes

Am J Infect Control. 2020 Jun;48(6):688-694. doi: 10.1016/j.ajic.2019.10.010. Epub 2019 Dec 3.

Authors

Leslie Dowson¹, N Deborah Friedman², Caroline Marshall³, Rhonda L Stuart⁴, Kirsty Buising⁵, Arjun Rajkhowa⁶, Fiona Gotterson⁷, David C M Kong⁸

Affiliations

¹ National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infections and Immunity, Melbourne, Victoria, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
² National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infections and Immunity, Melbourne, Victoria, Australia; School of Medicine, Deakin University, Geelong, Victoria, Australia; Department of General Medicine and Department of Infectious Diseases, Barwon Health, Geelong, Victoria, Australia.
³ National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infections and Immunity, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia; Victorian Infectious Diseases Service, Peter Doherty Institute for Infections and Immunity, Melbourne, Victoria, Australia; Infection Prevention and Surveillance Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
⁴ National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infections and Immunity, Melbourne, Victoria, Australia; Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; Monash Infectious Diseases and Infection Control and Epidemiology, Monash Health, Clayton, Victoria, Australia.
⁵ National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infections and Immunity, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia; Victorian Infectious Diseases Service, Peter Doherty Institute for Infections and Immunity, Melbourne, Victoria, Australia.
⁶ National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infections and Immunity, Melbourne, Victoria, Australia.
⁷ National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infections and Immunity, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
⁸ National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infections and Immunity, Melbourne, Victoria, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Pharmacy Department, Ballarat Health Services, Ballarat, Victoria, Australia. Electronic address: david.kong@monash.edu.

PMID: 31806238
DOI: 10.1016/j.ajic.2019.10.010

Abstract

Background: The objective of this study was to understand how aged care home health professionals perceive antimicrobial use near the end of life and how they perceive potential antimicrobial stewardship activities near the end of life in aged care homes.

Methods: Qualitative semi-structured interviews were undertaken with general practitioners, nurses, and pharmacists who provide routine care in aged care homes in Victoria, Australia. Interviews were coded using frameworks for understanding behavior change.

Results: Themes were established within 14 interviews, and an additional 6 interviews were undertaken to ensure thematic saturation. Two major themes emerged: (i) Antimicrobial stewardship activities near the end of life in aged care homes need to enable aged care home nurses to make decisions substantiated by evidence-based clinical knowledge. Antimicrobial stewardship should clearly be part of an aged care home nurse's role, and accreditation standards provide powerful motivation for behavior change. (ii) Antimicrobial stewardship activities near the end of life in aged care homes must address family confidence in resident wellbeing. Antimicrobial stewardship activities should be inclusive of family involvement, and messages should highlight the point that antimicrobial stewardship improves care.

Conclusions: Antimicrobial stewardship activities that reinforce evidence-based clinical decision-making by aged care home nurses and address family confidence in resident wellbeing are required near the end of life in aged care homes. Accreditation standards are important motivators for behavior change in aged care homes.

Keywords: Anti-infective agents; Antibacterial agents; Long-term care; Nursing homes; Palliative care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Antimicrobial Stewardship*
Death
Homes for the Aged
Humans
Qualitative Research
Victoria