Nurse and Medical Provider Perspectives on Antibiotic Stewardship in Nursing Homes

Objectives: To examine perspectives on antibiotic use and antibiotic stewardship of nurses and medical providers in nursing homes (NHs).

Design: Cross-sectional survey.

Setting: NHs in North Carolina (N = 31).

Participants: Nursing staff (n = 182) and medical providers (n = 50).

Measurements: Respondents completed a self-administered questionnaire about their perspectives on antibiotic use in their NH, the influence of residents and families on antibiotic prescribing decisions, and readiness to improve antibiotic stewardship. Open-ended questions on barriers to antibiotic stewardship were also asked. Linear mixed modeling was used to analyze differences between respondent groups and to test for associations with individual and organizational characteristics.

Results: All respondents supported reducing antibiotic use, although medical providers' support was significantly stronger (P = .005). When asked about their perception of residents' and family members' preference for antibiotic use in the case of suspected infection and the influence of that preference on antibiotic-prescribing decisions, respondents indicated that residents and families favor antibiotic use and influence prescribing decisions. Nurses reported a stronger perception than medical providers that families prefer antibiotics (P = .04) and influence prescribing decisions (P = .02). All respondents reported commitment and efficacy to change practices (mean 4.0-4.1 for nurses and 3.6-3.9 for medical providers on a 5-point scale). Four significant associations related to organizational and individual characteristics were found: directors of nursing and specialist nurses reported greater self-efficacy for changing practice than other nurses (P = .003), medical providers with a subspecialty (e.g., geriatrics) reported greater self-efficacy (P = .007) and commitment to change (P = .001) than those without a subspecialty, and medical providers specializing in hospice and palliative care rated family influence (P = .006) higher than those with other subspecialties.

Conclusion: Nursing staff and medical providers share a commitment to reducing unnecessary antibiotic use. Antibiotic stewardship interventions should foster cooperation and build competency to implement alternative management approaches and to educate residents and families. Nurse leaders and medical providers with long-term care training may be especially effective champions for antibiotic stewardship.