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A Cluster Randomized Trial to Assess the Impact of Facilitated Implementation on Antibiotic Stewardship in Wisconsin Nursing Homes

Awarded in 2017
Collaborative Health Sciences Program
Updated Sep 11, 2023

At a Glance

The overuse and misuse of antibiotics in Wisconsin nursing homes is a public health problem as unnecessary prescriptions can lead to antibiotic resistance. This project’s goal was to improve the quality and safety of antibiotic prescribing in Wisconsin nursing homes.

By partnering with Wisconsin nursing homes, and the Wisconsin Department of Health Services, the grant team is supporting the implementation and dissemination of an intervention of a urinary tract infection (UTI) toolkit, to promote antibiotic stewardship in nursing homes.

The Challenge

Overuse and misuse of antibiotics is a public health problem in Wisconsin nursing homes. Treatment of suspected urinary tract infections (UTI) accounts for nearly half of the antibiotic use in nursing homes, but many of these prescriptions are unnecessary. This can lead to antibiotic resistance, where existing antibiotic medications are no longer able to remedy previously treatable infections.

Project Goals

This project’s long-term objective was to improve the quality and safety of antibiotics prescribing in Wisconsin nursing homes. This goal was addressed through two specific aims. First, researchers aimed to evaluate the impact of the Wisconsin UTI Improvement Toolkit on antibiotic prescribing for UTIs in Wisconsin nursing homes. For each suspected UTI event, this toolkit allowed nursing homes to enter anonymous data on resident signs and symptoms, urine cultures, antibiotic orders, and whether criteria for antibiotic use were met. Second, they planned to assess the influence of external facilitation, including a clinical coach, collaborative peer learning, and peer comparison feedback on the adoption and effect of the Wisconsin UTI Improvement Toolkit in those facilities.

Results

As a result of the work on this project, the researchers have developed and strengthened relationships with approximately 20 nursing homes across the state of Wisconsin, key members of the Wisconsin Department of Health Services, long-term care professional organizations like the Wisconsin Medical Directors Association, and LeadingAge, a major nursing home advocacy group.

The grant team is preparing online presentation materials for the Wisconsin Department of Health Services to support wide dissemination of the UTI toolkit that was studied during the project, and developing materials to train DHS staff to coach Wisconsin nursing home staff in how the initiate and sustain toolkit implementation.

Additionally, the findings from this study were presented at annual scientific meetings and submitted as various manuscripts.

Improving antibiotic stewardship in Wisconsin nursing homes

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