Work smarter: Testing a decision-making tool for antibiotic use

Antibiotics were once seen as a cure-all, but their heavy use over the years has increased the prevalence of antibiotic-resistant bacteria. This poses a tremendous public health risk, leading to the call for better standards for antibiotic use. Nursing homes make heavy use of antibiotics, with between 47 and 79 percent of residents receiving at least one course of antibiotics per year. Reducing unnecessary antibiotic use is vital for slowing antibiotic resistance, but as antibiotics are sometimes needed to fight an infection, figuring out when to use antibiotics can be a challenge.

To that end, a research team led by Darcy McMaughan, PhD, assistant professor in the Health Policy & Management Department and director of the Program on Disability Research and Community Based Care at the Texas A&M School of Public Health, looked into the effectiveness of a decision-making tool for proper antibiotic use by nursing home staff. The study, published in the journal BMC Geriatrics, examined the rates of antibiotic prescriptions for urinary tract infections (UTIs) in 12 Texas nursing homes.

Two of the most common sources of inappropriate antibiotic use are preventive use of antibiotics and prescribing antibiotics without clear indication of an infection. UTIs are common ailments affecting the quality of care for nursing home residents. Up to a third of the antibiotic prescriptions in nursing homes are for suspected UTIs, but a substantial number of these infections are without symptoms and are only diagnosed through the presence of bacteria in urine. Treating asymptomatic UTIs with antibiotics has been shown to have little benefit and could potentially be harmful.

These facts together make UTIs a natural starting point for reducing inappropriate antibiotic use. The trick is helping busy nursing home staff make the right decisions.

“We created a decision-making tool with the help of technical experts from the Texas Department of Disability and Aging Services, nursing home administrators and infection control experts,” McMaughan said. “Our hypothesis was that this decision-making tool would be effective at helping nursing home staff use antibiotics more appropriately.”

The research team then assigned 12 nursing homes into three groups. Two groups received the decision-making tool—one with minimal training and one with extensive training—and one group served as a control. The researchers studied medical records for six months before and after the introduction of the tool to measure how much it affected antibiotic prescription rates, if at all.

“The decision-making tool helped significantly reduce antibiotic use for asymptomatic UTIs, with the nursing homes receiving both the tool and higher levels of training seeing the largest decreases,” McMaughan said. “However, improvements were not sustainable, as these nursing homes soon stopped using the decision-making tool.”

McMaughan said this indicates a need for future work that focuses on making it easier for busy nursing home professionals to keep using a tool that adds to their workloads, perhaps through a staff member dedicated to implementing the tool.