Development of a Stewardship Intervention for CLC Pharmacists to Improve UTI Treatments

为 CLC 药剂师制定管理干预措施以改善 UTI 治疗

基本信息

批准号：
10295040
负责人：
Haley J Appaneal
金额：
--
依托单位：
PROVIDENCE VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-10-01 至 2022-09-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10295040
关键词：
Accountability Adverse drug event Advisory Committees Algorithms Antibiotic Therapy Antibiotics Award Back Bacteremia Bacterial Antibiotic Resistance CLC Gene Caring Centers for Disease Control and Prevention (U.S.)Clinical Pharmacists Clostridium difficile Communicable Diseases Complex Data Data Reporting Databases Development Diagnosis Dose Drug Interactions Education Educational Intervention Effectiveness Elements Engineering Ensure Environment Feedback Foundations Frequencies Funding Future Goals Health Services Research Health care facility Hepatic Hospitalization Hospitals Human Infection Intervention Interview Kidney Leadership Literature Long-Term Care Measures Medical center Mentorship Methodology Modeling National Security Nurses Outcome Patients Pharmaceutical Preparations Pharmacists Pharmacotherapy Pharmacy facility Population Positioning Attribute Provider Public Health Qualitative Methods Quality of Care Reporting Research Research Methodology Resistance Role Safety Secure Selection for Treatments Symptoms System Testing Time Training United States Urinary tract infection Veterans Work acute care antibiotic resistant infections bacterial resistance base career community living design effectiveness evaluation experience flexibility implementation research implementation tool improved informant innovation patient safety pilot test primary outcome programs rapid growth response secondary outcome therapy design tool unnecessary treatment

项目摘要

In the long-term care (LTC) setting, 70% of residents receive at least one course of antibiotics each year and up to 75% of this use is reported to be inappropriate or unnecessary. The harms of antibiotic misuse in frail older LTC residents are significant, including Clostridium difficile infection, adverse drug events and drug interactions, and colonization and/or infection with resistant bacteria. This crisis has prompted the President of the United States to formally recognize antibiotic misuse and resistance as a global public health crisis and a key national security threat. In response, the Centers for Disease Control (CDC) recently outlined Core Elements to improve antibiotic use in long-term care facilities (LTCFs) and mandate that at least one Core Element be implemented immediately. While these Core Elements are timely, they are based on data extrapolated from acute care hospitals, an environment that differs substantially from LTC. Effective and financially resourceful antibiotic stewardship interventions to improve patient safety in LTCFs remain unknown and absent, particularly within the VA. As such, there is a critical need for the development of tailored antibiotic stewardship interventions to improve the care of the 50,000+ Veterans who reside in VA LTCFs (known as community living centers or CLCs) annually. Treatment of suspected urinary tract infection (UTI) is the largest contributor to antibiotic use in LTCFs. Much of this use is unnecessary and/or inappropriate. My recent work showed that over 50% of initial antibiotic selection for suspected UTI was inappropriate at two VA CLCs. There is a vast amount of literature targeting providers and nurses evaluating interventions designed to improve the appropriate diagnosis of UTI. However, focused on diagnosis, these studies have failed to correct inappropriate treatment selection when antibiotics are truly indicated. This is extremely concerning as true UTIs are the most common cause of hospitalization in LTC residents and the number one cause of bacteremia. Clinical pharmacists are drug therapy experts and are ideally suited to correct inappropriate UTI antibiotic therapy. Therefore, I hypothesize that an educational program targeting CLC pharmacists will lead to improved antibiotic use for UTIs. My long-term goal is to improve the quality of care of residents nationally through reduction of inappropriate antibiotic use. Accordingly, the work proposed, creates, implements, and tests a feasible “real world” model for antibiotic stewardship in VA CLCs. This model places the pharmacist in a prominent antibiotic stewardship role by taking advantage of a pharmacist’s expertise in guiding appropriate antibiotic use, while using the pharmacist as a consistent presence for many CLCs. This model was specifically designed with the ability to disseminate this work to VA CLCs nationally. To improve the utility of this model, interventions will be based off facility-specific antibiotic use rates and antibiograms. The objectives of this proposal are to pilot test the implementation and effectiveness of our antibiotic stewardship intervention through three specific aims: Aim 1. To describe antibiotic use and inappropriate antibiotic use for suspected culture positive UTI among VA CLCs nationally and identify independent predictors of inappropriate antibiotic use. Aim 2. To develop an educational intervention targeting CLC pharmacists to reduce inappropriate treatment of UTIs and pilot test the intervention in two CLCs. Aim 3. To evaluate the effectiveness of the educational intervention on UTI related antibiotic use (primary outcome), and the frequency of inappropriate antibiotic use, and absence of de-escalation by day 4. The proposed research is significant, because it is expected to result in an intervention that can be disseminated broadly to effectively improve antibiotic use, and ultimately improve resident safety through reduction of antibiotic resistant infections in CLCs nationally.

在长期护理（LTC）环境中，每年有70％的居民至少接受一种抗生素课程据报道，多达75％的使用是不适当的或不必要的。虚弱的抗生素遗物的危害老年LTC居民很重要，包括艰难梭菌感染，不良药物事件和药物相互作用，与抗性细菌的定殖和/或感染。这场危机促使美国正式认识到抗生素的遗物和抵抗是全球公共卫生危机，主要国家安全威胁。作为回应，疾病控制中心（CDC）最近概述了核心改善长期护理设施（LTCF）抗生素使用的元素，并要求至少一个核心元素应立即实现。尽管这些核心元素是及时的，但它们基于数据从急性护理医院推断出，这种环境与LTC有很大不同。有效和在财务上足智多谋的抗生素管理干预措施以提高LTCF的患者安全性仍然未知而且缺席，尤其是在VA中。因此，迫切需要开发量身定制的抗生素管理居住在VA LTCF的50,000多名退伍军人的护理干预措施（称为每年社区生活中心或CLC）。可疑的尿路感染（UTI）的治疗是LTCF中抗生素使用的最大贡献者。很多此用途是不必要的和/或不合适的。我最近的工作表明，超过50％的初始抗生素在两个VA CLC上选择可疑的UTI是不合适的。有大量的文献定位提供者和护士评估旨在改善UTI诊断的干预措施。然而，专注于诊断，这些研究未能纠正抗生素时的不适当治疗选择真正指示。这是非常关注的，因为真正的尿路斯是住院的最常见原因 LTC居民和细菌的第一原因。临床药剂师是药物治疗专家，是非常适合纠正不适当的UTI抗生素疗法。因此，我假设是一个教育针对CLC药剂师的程序将导致尿路斯的抗生素使用改善。我的长期目标是通过减少不适当的抗生素使用来提高全国居民的护理质量。提出的作品提出，创建，实施和测试了可行的“现实世界”模型，用于抗生素管理 VA CLC。该模型通过利用药剂师在使用药剂师一致的同时指导适当的抗生素使用专家许多CLC的存在。该模型是专门设计的，具有将这项工作传播到VA的能力 CLC在全国范围内。为了改善该模型的实用性，干预措施将基于设施特定的抗生素使用速率和抗体图。该提案的目标是试行测试实施和我们的抗生素管理干预的有效性通过三个特定目的：目的1。描述使用抗生素的使用和不适当的抗生素用途，以使VA之间的据估计培养物阳性uti CLC在全国范围内，确定不适当使用抗生素的独立预测指标。目标2。开发针对CLC药剂师的教育干预措施，以减少对 UTI和试点测试两个CLC的干预措施。目的3。评估教育干预对UTI相关抗生素使用的有效性（主要结果），以及不适当的抗生素使用的频率，以及第4天缺乏降级的频率。拟议的研究很重要，因为有望导致干预措施广泛传播以有效改善抗生素的使用，并最终通过全国CLC中抗生素耐药性感染的减少。

项目成果

期刊论文数量（6）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Predictors of potentially suboptimal treatment of urinary tract infections in long-term care facilities.

DOI：
10.1016/j.jhin.2021.01.019
发表时间：
2021-04
期刊：
The Journal of hospital infection
影响因子：
0
作者：
Appaneal HJ;Caffrey AR;Lopes VV;Mor V;Dosa DM;LaPlante KL;Shireman TI
通讯作者：
Shireman TI

Poor clinical outcomes associated with suboptimal antibiotic treatment among older long-term care facility residents with urinary tract infection: a retrospective cohort study.

DOI：
10.1186/s12877-021-02378-5
发表时间：
2021-07-23
期刊：
BMC geriatrics
影响因子：
4.1
作者：
Appaneal HJ;Shireman TI;Lopes VV;Mor V;Dosa DM;LaPlante KL;Caffrey AR
通讯作者：
Caffrey AR

Trends in Collection of Microbiological Cultures Across Veterans Affairs Community Living Centers in the United States Over 8 Years.

8 年来美国退伍军人事务社区生活中心微生物培养物收集的趋势。

DOI：
10.1016/j.jamda.2019.07.003
发表时间：
2020
期刊：
Journal of the American Medical Directors Association
影响因子：
7.6
作者：
Appaneal,HaleyJ;Caffrey,AislingR;Hughes,Maria-StephanieA;Lopes,VrishaliV;Jump,RobinLP;LaPlante,KerryL;Dosa,DavidM
通讯作者：
Dosa,DavidM