The OASIS Collaborative is an organizational intervention aimed at reducing unnecessary antibiotic use in skilled nursing facilities. The first target of intervention is the tasks carried out by nursing staff after a change in condition and after an antibiotic prescription is initiated. The second target are the management staff who provide feedback to staff. The third target are the administrators who identify and overcome organizational barriers to implementation. In this study, we will implement two tools that are intended to minimize unnecessary antibiotic use in skilled nursing facilities. The first tool helps skilled nursing facility staff assess risk and communicate with prescribers when residents experience a change in health status that may result in the use of antibiotics. The second tool is used after an antibiotic is prescribed; the tool streamlines reassessment of the patient, and provides prescribers the opportunity to consider stopping unnecessary antibiotic prescriptions, narrowing the spectrum of antibiotic therapy, or shortening the duration of antibiotic therapy.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
2,942
OASIS (Optimizing Antibiotic Stewardship in Skilled Nursing Facilities) is a system redesign of skilled nursing facility work systems
Days of Antibiotic Therapy (DOT)/1000 resident days
Utilization of antibiotics initiated in the nursing home, defined as the number of days a nursing home resident receives antibiotic therapy. This measure includes antibiotic courses initiated 1) in the nursing home or 2) Emergency Department, if the resident returned to the nursing home without intercurrent hospitalization. This measure excludes antibiotic courses started during a hospital stay and continued in the nursing home after discharge.
Time frame: up to 12 months
Proportion of Antibiotic Starts meeting Loeb Criteria
Defined as the proportion of antibiotic courses started in the nursing home or Emergency department that satisfy the Loeb minimum criteria for initiation of antibiotics. This measure includes antibiotic courses initiated 1) in the nursing home or 2) Emergency Department, if the resident returned to the nursing home without intercurrent hospitalization. This measure excludes antibiotic courses started during a hospital stay and continued in the nursing home after discharge.
Time frame: up to 12 months
Incidence of antibiotic starts/1000 resident days
Defined as the number of antibiotic courses started per 1000 resident days. This measure includes antibiotic courses initiated 1) in the nursing home or 2) Emergency Department, if the resident returned to the nursing home without intercurrent hospitalization. This measure excludes antibiotic courses started during a hospital stay and continued in the nursing home after discharge.
Time frame: up to 12 months pre-implementation and up to 12 months post-implementation
Fluoroquinolone Days of Therapy (FQD)/1000 resident days
Defined as the number of days a nursing home resident receives fluoroquinolone therapy. This measure includes antibiotic courses initiated 1) in the nursing home or 2) Emergency Department, if the resident returned to the nursing home without intercurrent hospitalization. This measure excludes antibiotic courses started during a hospital stay and continued in the nursing home after discharge.
Time frame: up to 12 months pre-implementation and up to 12 months post-implementation
Incidence of C.diff infection/1000 resident days
Defined as the number of positive C. difficile tests per 1000 resident days
Time frame: up to 12 months pre-implementation and up to 12 months post-implementation
Fluoroquinolone resistance
Defined as the proportion of urine cultures that grow bacteria that are resistant to fluoroquinolone antibiotics.
Time frame: up to 12 months pre-implementation and up to 12 months post-implementation
Positive Enterococcus species
Defined as the proportion of urine cultures that grow Enterococcus species
Time frame: up to 12 months pre-implementation and up to 12 months post-implementation
Positive Candida species
Defined as the proportion of urine cultures that grow Candida species
Time frame: up to 12 months pre-implementation and up to 12 months post-implementation
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