Effect of antibiotic time-outs on modification of antibiotic prescriptions in nursing homes

2020 ◽  
Vol 41 (6) ◽  
pp. 635-640
Author(s):  
Chi-Yin Liao ◽  
David A. Nace ◽  
Christopher J. Crnich ◽  
Mozhdeh Bahrainian ◽  
James H. Ford
Keyword(s):  
Nursing Homes ◽  
Broad Spectrum ◽  
Intervention Study ◽  
Early Discontinuation ◽  
Antibiotic Overuse ◽  
Potential Value ◽  
Time Out ◽  
Before And After ◽  
And Control ◽  
The Impact

AbstractBackground:Antibiotic overuse and misuse is a common problem in nursing homes. Antibiotic time-out (ATO) interventions have led to improvements in antibiotic uses in hospitals, but their impact in nursing homes remain understudied.Objective:To evaluate the impact of a stewardship intervention, promoting use of ATOs on the frequency and types of antibiotic change events (ACEs) in nursing homes.Design:Controlled before-and-after intervention study.Setting:Nursing homes in Wisconsin and Pennsylvania.Method:Data on antibiotic prescriptions in 11 nursing homes were collected for 25 months. We categorized ACEs as (1) early discontinuation, (2) class modification, or (3) administration modification. Class modification ACEs were further classified based on whether the change narrowed, expanded, or had no effect on bacterial spectrum coverage. Analyses were performed using a difference-in-difference (DiD) approach.Result:Of 2,647 antibiotic events initiated in study nursing homes, 376 (14.2%) were associated with an ACE. The overall proportion of ACEs did not significantly differ between intervention and control nursing homes. Early discontinuation ACEs increased in intervention nursing homes (DiD, 2.5%; P = .01), primarily affecting residents initiated on broad-spectrum antibiotics (DiD, 2.9%; P < .01). Class modification ACEs decreased in intervention nursing homes but remained unchanged in control nursing homes.Conclusion:The impact of an ATO intervention in study nursing homes was mixed with increases in early discontinuation ACEs offset by reductions in class modification ACEs. More research on the potential value of ATO interventions in nursing homes is warranted.

scholarly journals 2050. Effect of a Stewardship Intervention on Post-Prescriptive Antibiotic Timeouts in Nursing Homes

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S691-S691
Author(s):  
Chi-Yin Liao ◽  
James H Ford ◽  
David A Nace ◽  
Christopher Crnich
Keyword(s):  
Nursing Homes ◽  
Antibiotic Stewardship ◽  
Common Type ◽  
Antibiotic Prescribing ◽  
Dose Frequency ◽  
Early Discontinuation ◽  
Antibiotic Overuse ◽  
Before And After ◽  
The Difference

Abstract Background Antibiotic overuse and misuse is a common problem in nursing homes (NHs). Meaningful improvements in the quality of antibiotic prescribing in NHs may be improved through post-prescriptive interventions (antibiotic timeouts) focused on stopping, streamlining and/or shortening ongoing antibiotic treatments. A recently completed trial of a complex antibiotic stewardship intervention provided us with an opportunity to explore to what extent NH providers engaged in antibiotic timeouts at baseline and the effects of the intervention on these behaviors. Methods Data on antibiotic prescriptions in 11 NHs (6 intervention, 5 control) were collected for 12 months prior and 13 months after intervention introduction. We categorized antibiotic change events (ACEs) as: (1) changes in dose, frequency, or route for the same antibiotic, (2) change to another antibiotic with different spectrum, and (3) early discontinuation (stopped after 2 days or less). Modifications considered to be routine (e.g., Azithromycin dose reduction from 500 to 250 mg) were not considered a meaningful ACE. Frequency of ACEs both overall and by type were compared using a difference in difference (DID) approach. Results Of 2647 NH initiated antibiotic events, 376 (14.2%) were modified over the study period. The most common type of modification was a change in spectrum (n = 241, 64.1%) followed by early discontinuation of the antibiotic (n = 118, 31.4%). The difference in ACEs before and after the intervention as well as DID estimates are detailed in the Table. Conclusion The antibiotic stewardship intervention did not impact total ACEs but did appear to increase the frequency of discontinuation ACEs. An inability to capture data on shortening ACEs (e.g., reducing a treatment course from 14 to 7 days) was a limitation of this study. Additional research on how to foster more frequent and effective antibiotic timeouts in NHs is needed. Disclosures All authors: No reported disclosures.

scholarly journals The impact of a ‘milking the COW’ campaign in a regional hospital in Singapore

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Surinder Kaur M. S. Pada ◽  
Poh Lishi ◽  
Kim Sim Ng ◽  
Sarathamani Rethenam ◽  
Lilibeth Silagan Alenton ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Pathogenic Bacteria ◽  
Mixed Model ◽  
Mixed Model Analysis ◽  
Colony Forming Units ◽  
Skin Flora ◽  
Before And After ◽  
The Difference ◽  
And Control ◽  
The Impact

Abstract Background Computerisation of various processes in hospitals and reliance on electronic devices raises the concern of contamination of these devices from the patient environment. We undertook this study to determine if an attached hand hygiene device that unlocks the screen of a computer on wheels (COW) on usage can be effective in decreasing the microbiological burden on computer keyboards. Methods An electronic hand sanitizer was integrated onto the COW. A prospective cohort study with a crossover design involving 2 control and 2 intervention wards was used. The study end point was the number of colony forming units found on the keyboards. Bacteria were classified into 4 main groups; pathogenic, skin flora, from the environment or those thought to be commensals in healthy individuals. We then used a mixed effects model for the statistical analysis to determine if there were any differences before and after the intervention. Results Thirty-nine keyboards were swabbed at baseline, day 7 and 14, with 234 keyboards cultured, colony forming units (CFUs) counted and organisms isolated. By mixed model analysis, the difference of mean bacteria count between intervention and control for week 1 was 32.74 (− 32.74, CI − 94.29 to 28.75, p = 0.29), for week 2 by 155.86 (− 155.86, CI − 227.45 to − 83.53, p < 0.0001), and after the 2-week period by 157.04 (− 157.04, CI − 231.53 to − 82.67, p < 0.0001). In the sub-analysis, there were significant differences of pathogenic bacteria counts for the Intervention as compared to the Control in contrast with commensal counts. Conclusion A hand hygiene device attached to a COW may be effective in decreasing the microbiological burden on computer keyboards.

scholarly journals Investigating the Impact of Brief Outings on the Welfare of Dogs Living in US Shelters

Animals ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 548
Author(s):  
Lisa M. Gunter ◽  
Rachel J. Gilchrist ◽  
Emily M. Blade ◽  
Rebecca T. Barber ◽  
Erica N. Feuerbacher ◽  
...  
Keyword(s):  
Stress Reduction ◽  
Physiological Measures ◽  
Urinary Cortisol ◽  
Short Term ◽  
Animal Shelters ◽  
Time Out ◽  
Before And After ◽  
Activity Measures ◽  
The Impact ◽  
Low Activity

Social isolation likely contributes to reduced welfare for shelter-living dogs. Several studies have established that time out of the kennel with a person can improve dogs’ behavior and reduce physiological measures of stress. This study assessed the effects of two-and-a-half-hour outings on the urinary cortisol levels and activity of dogs as they awaited adoption at four animal shelters. Dogs’ urine was collected before and after outings for cortisol:creatinine analysis, and accelerometer devices were used to measure dogs’ physical activity. In total, 164 dogs participated in this study, with 793 cortisol values and 3750 activity measures used in the statistical analyses. We found that dogs’ cortisol:creatinine ratios were significantly higher during the afternoon of the intervention but returned to pre-field trip levels the following day. Dogs’ minutes of low activity were significantly reduced, and high activity significantly increased during the outing. Although dogs’ cortisol and activity returned to baseline after the intervention, our findings suggest that short-term outings do not confer the same stress reduction benefits as previously shown with temporary fostering. Nevertheless, it is possible that these types of outing programs are beneficial to adoptions by increasing the visibility of dogs and should be further investigated to elucidate these effects.

scholarly journals Changes in the Use of Broad-Spectrum Antibiotics after Cefepime Shortage: a Time Series Analysis

2011 ◽  
Vol 56 (2) ◽  
pp. 989-994 ◽  
Author(s):  
C. Plüss-Suard ◽  
A. Pannatier ◽  
C. Ruffieux ◽  
A. Kronenberg ◽  
K. Mühlemann ◽  
...  
Keyword(s):  
Time Series ◽  
Pseudomonas Aeruginosa ◽  
Broad Spectrum ◽  
Interrupted Time Series ◽  
Antibiotic Policy ◽  
Content Type ◽  
Broad Spectrum Antibiotics ◽  
Before And After ◽  
Alternative Antibiotic ◽  
The Impact

ABSTRACTThe original cefepime product was withdrawn from the Swiss market in January 2007 and replaced by a generic 10 months later. The goals of the study were to assess the impact of this cefepime shortage on the use and costs of alternative broad-spectrum antibiotics, on antibiotic policy, and on resistance ofPseudomonas aeruginosatoward carbapenems, ceftazidime, and piperacillin-tazobactam. A generalized regression-based interrupted time series model assessed how much the shortage changed the monthly use and costs of cefepime and of selected alternative broad-spectrum antibiotics (ceftazidime, imipenem-cilastatin, meropenem, piperacillin-tazobactam) in 15 Swiss acute care hospitals from January 2005 to December 2008. Resistance ofP. aeruginosawas compared before and after the cefepime shortage. There was a statistically significant increase in the consumption of piperacillin-tazobactam in hospitals with definitive interruption of cefepime supply and of meropenem in hospitals with transient interruption of cefepime supply. Consumption of each alternative antibiotic tended to increase during the cefepime shortage and to decrease when the cefepime generic was released. These shifts were associated with significantly higher overall costs. There was no significant change in hospitals with uninterrupted cefepime supply. The alternative antibiotics for which an increase in consumption showed the strongest association with a progression of resistance were the carbapenems. The use of alternative antibiotics after cefepime withdrawal was associated with a significant increase in piperacillin-tazobactam and meropenem use and in overall costs and with a decrease in susceptibility ofP. aeruginosain hospitals. This warrants caution with regard to shortages and withdrawals of antibiotics.

scholarly journals Analysis of Linkages between Environmental Policy Instruments and Innovation: A Case Study of End-of-Life Vehicles Technologies in Japan

2016 ◽  
Vol 9 (2) ◽  
pp. 181 ◽  
Author(s):  
Rajeev Kumar Singh ◽  
Helmut Yabar ◽  
Rie Murakami-Suzuki ◽  
Noriko Nozaki ◽  
Randeep Rakwal
Keyword(s):  
Environmental Policy ◽  
End Of Life ◽  
Environmental Regulations ◽  
Policy Instruments ◽  
Control Policy ◽  
Before And After ◽  
Exogenous Factors ◽  
And Control ◽  
The Impact

<p>Environmental policies are designed to deal with externalities either by internalizing environmental costs or imposing specific standards for environmental pollution. This study aims to examine the impact of environmental regulations related to End-of-Life Vehicles (ELV) on innovation in Japan. We determined whether there is any statistical difference in patent activity comparing the periods before and after the regulations were enacted. In order to control for exogenous factors such as business cycles, we also analyzed the ratios of ELV and total environmental patents during the same periods. Results showed that environmental regulations drive innovations and the number of ELV-related patents were larger even after controlling for such exogenous factors. We concluded that environmental policy for ELV in Japan was effective in inducing innovation. However, we also found that the weakness in these types of command and control policy is the lack of incentives for further innovation.</p>

scholarly journals How is Satiety Affected When Consuming Food While Working on A Computer?

Nutrients ◽  
2019 ◽  
Vol 11 (7) ◽  
pp. 1545 ◽  
Author(s):  
Lily Ding ◽  
Nazimah Hamid ◽  
Daniel Shepherd ◽  
Kevin Kantono
Keyword(s):  
Energy Intake ◽  
Eating Behavior ◽  
Normal Weight ◽  
Restrained Eating ◽  
Computer Work ◽  
Meal Intake ◽  
Significant Difference ◽  
Before And After ◽  
And Control ◽  
The Impact

More people working at offices are choosing to eat meals at their desks, making “desktop dining” an increasingly common phenomenon. Previous studies have reported that environmental distractors, such as television viewing, can influence meal intake and subsequent snack intake. However, the impact of stressful mental tasks on eating behavior has received relatively less attention, focusing only on subsequent meal intake or concurrent snack intake. This study sets out to determine whether eating while working influenced current meal energy intake. This research also examined the relationship between dietary restraint status and energy intake. A crossover experimental design was employed requiring participants (14 males and 29 females) to eat pizza quietly and at rest (control), and while working on a computer (work). Measurements included BMI, energy intake, state anxiety, restrained eating behavior, stress levels (pre- and post-eating), and appetite (before and after both work and control sessions). The findings showed that consuming food while working on a computer significantly increased stress but had no influence on energy intake compared to the control condition. However, post-eating hunger levels were significantly higher in the work condition compared to the control condition. As expected, satiety levels decreased significantly from pre- to post-eating for both work and control conditions. In addition, no significant relationship was observed between restrained eating behavior and energy intake in both work and control conditions. These results suggest that eating while working affected satiety of normal weight participants, as indicated by the significant difference in post-meal satiety levels between work and control conditions.

The impact of person-centered care on residents' perceptions of care quality in nursing homes: an intervention study

2018 ◽  
Vol 7 (2) ◽  
pp. 118-124
Author(s):  
Vigdis Abrahamsen Grøndahl ◽  
Liv Berit Fagerli ◽  
Heidi Karlsen ◽  
Ellen Rosseland Hansen ◽  
Helena Johansson ◽  
...  
Keyword(s):  
Nursing Home ◽  
Intervention Study ◽  
Care Quality ◽  
Legal Rights ◽  
Nursing Home Administrators ◽  
Person Centered Care ◽  
Before And After ◽  
Centered Care ◽  
The Impact ◽  
Perceptions Of Care

Background: The quality of care offered to older people is still poor. Nursing home administrators often claim that they provide person-centered care, but research indicates that institutional goals take precedence. Aim: The aim was to explore the impact of person-centered care on residents’ perceptions of care quality.  Methods: An intervention study was conducted in one nursing home (41 residents). Person-centered care was operationalized into the interventions: greeting the resident on each shift, one-to-one contact (resident – carer) for 30 minutes twice a week, informing the residents continuously about changes in medication, and informing the residents about their legal rights at admission and three months after admission. The interventions were systematically conducted for 12 months. Face-to-face interviews using the Quality from Patient’s Perspective (QPP) questionnaire were conducted both prior to interventions and immediately after the 12-month period. Descriptive and comparative statistics were used to test for differences between care quality perceptions before and after intervention (p ≤ .05). Results: The residents rated all four quality dimensions (caregivers’ medical-technical competence and identity-oriented approach, care organization’s socio-cultural atmosphere, and physical-technical conditions) more highly after the 12-month period, and the socio-cultural atmosphere was rated significantly more highly. At item level, 44 items received higher scores, and, among them, significantly higher scores were given to 6 items. One item received a significantly lower score. Conclusions: Residents’ perceptions of care quality increase when person-centered care is operationalized and takes precedence over the ward’s routines or is part of the ward’s routines. The results indicate that it is possible to design a care system where the residents are at the centre of the health care offered.

scholarly journals 1033. Effectiveness of a Physician-Driven Automated Antibiotic Time Out in the Setting of Gram-negative Bacteremia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S363-S364
Author(s):  
Sana Mohayya ◽  
Navaneeth Narayanan ◽  
Daniel Cimilluca ◽  
Parth Vaidya ◽  
Alexander Malanowski ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Primary Outcome ◽  
Secondary Outcome ◽  
Antibiotic Prescribing ◽  
Gram Negative ◽  
Time Out ◽  
Days Of Therapy ◽  
Gram Negative Bacteremia ◽  
Secondary Outcomes ◽  
The Impact

Abstract Background In an effort to minimize complications associated with over-utilization of antibiotics, many antimicrobial stewardship programs have incorporated an antibiotic time out (ATO). Despite the increasing adoption of the ATO, limited data are available to support its effectiveness. This study was designed to assess the impact of an automated ATO integrated into the electronic medical record (EMR) on the rate of antibiotic modification in patients receiving broad-spectrum antibiotic(s) for Gram-negative bacteremia (GNB). Methods This was a single-center retrospective cohort study of inpatients from January 2017 to June 2018 conducted at a large academic medical center. ATO was implemented on October 31, 2017. Adult patients with GNB who received at least 72 hours of a systemic antibiotic were included. Patients with neutropenia or polymicrobial infections were excluded. The primary outcome was the proportion of patients who received a modification of therapy within 24 hours of final culture results. Secondary outcomes included modification at any point in therapy, time to modification of therapy, time to de-escalation, and days of therapy of broad-spectrum antibiotics. Results There was a total of 88 patients who met inclusion criteria, 37 patients pre-ATO and 51 patients post-ATO. The primary outcome of modification of therapy within 24 hours of final culture results was not significantly different for patients in the pre-ATO and post-ATO groups (19% vs. 20%, P = 0.94, respectively). The secondary outcome of modification of therapy at any point in therapy was not significantly different between the two groups (62% vs. 66%, P = 0.67). Of the 47 patients who received a modification of therapy, the mean time to modification was significantly shorter in the post-ATO group (52.8 hours vs. 45.26 hours, P < 0.05,). All other secondary outcomes were not significantly different between study groups. Conclusion The ATO alert was not associated with a higher rate of antibiotic modification within 24 hours of culture results in patients with GNB, although there was a significant reduction in the time to antibiotic modification. Further efforts are needed to improve the time to modification and optimize antibiotic prescribing practices. Disclosures All authors: No reported disclosures.

scholarly journals 1039. Forty-eight-hour Antibiotic Time-out: Impact on Antibiotic Duration and Clinical Outcomes

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S365-S366
Author(s):  
Natasha N Pettit ◽  
Palak Bhagat ◽  
Cynthia T Nguyen ◽  
Victoria J L Konold ◽  
Madan Kumar ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Medical Center ◽  
Inpatient Setting ◽  
Core Element ◽  
Time Out ◽  
Before And After ◽  
Control And Prevention ◽  
Quasi Experimental ◽  
Tract Infections ◽  
The Impact

Abstract Background A core element of the Centers for Disease Control and Prevention Antimicrobial Stewardship standard for the inpatient setting includes a 48-hour antibiotic time-out (ATO) process to reassess antibiotic indication. We implemented an automated alert in the electronic health record (EHR) that identifies patients that have received >=48hours of antibiotic therapy. The alert requires the clinician (physician or pharmacist) to note an indication for continuation or plan for discontinuation. Within the alert, a dashboard was developed to include relevant patient information (e.g., temperature, white blood cell count, microbiology, etc). We sought to evaluate the impact of the ATO alert on the duration of therapy (DOT) of cefepime (CFP), ceftazidime (CTZ) and vancomycin (VAN), for the treatment of pneumonia (PNA) and urinary tract infections (UTI) for adult and pediatric patients. Methods This quasi-experimental, retrospective analysis included adult and pediatric patients that received ≥48 hours of CFP, CTZ, or VAN for UTI or PNA between April 1, 2017 and July 31, 2017 (pre-48H ATO) and October 1, 2018–December 31, 2018 (post-48H ATO). Fields at order-entry to specify an antibiotic indication were not available prior to our EHR interventions. A randomized subset from the Pre-48Hr ATO group was selected for detailed analysis. The primary endpoint was to evaluate the average DOT of CFP/CTZ combined, VAN alone, and the combination of CFP/CTZ/VAN. We also evaluated length of stay (LOS), all-cause inpatient mortality, and 30-day readmissions. Results A total of 157 antibiotic orders (n = 94 patients) were evaluated in the pre-48h ATO group, and 2093 antibiotic orders (n = 521 patients) post-48H ATO group. Pre-48H ATO, 85 patients received CFP/CTZ and 72 VAN. Post-48H ATO, 322 patients received CFP/CTZ and 198 VAN. PNA was the most common indication pre- and post-48H ATO. DOT significantly decreased pre- vs. post-48H ATO (Figure 1). LOS was 2 days shorter (P = 0.01) in the post-48H ATO group, mortality and 30-day readmissions was similar between groups (Table 1). Conclusion Average antibiotic DOT for CFP/CTZ, and VAN significantly decreased following the implementation of the 48H ATO at our medical center. LOS was reduced by 2 days, while mortality and 30-day readmissions were similar before and after. Disclosures All authors: No reported disclosures.

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