Antibiotic Stewardship for Nursing Homes

Antibiotic Stewardship Program for Nursing Homes

Studies have shown that about 70% of patients in the nursing homes receive antibiotic medication, but the discomfiting fact is that 40 -75 % of those drugs are either administered inappropriately or they should not have been the primary option. Due to existence of such problems, the Centers for Disease Control and Prevention (CDC) embarked on improving the use of antibiotics. However, for the program to succeed, there is a need for behavioral change towards how the prescribing is done. The reason for antibiotic stewardship program not being implemented in the hospital culture is that it comes with new procedures, which the doctors find hard to adapt.

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Goal Statement

Thus, the Antibiotic Stewardship Program was initiated in hospitals to improve treatment of infections and mitigate the side effects of drugs, help the medical practitioners strengthen their services to patients and also, reduced the recovery time (Kubin, 2008).  The program also aims at reducing microorganism resistance to drugs, and significantly lowering the frequency of patients visiting health care facilities due to repeated infections. Under this program, the medical department is able to utilize its resources efficiently and thus, increase savings.

Objectives of Behavioral Change

The hospitals have a culture, which makes the doctors behave in a certain way, including the manner of drugs prescription. Some of these customs and traditions lead to adverse side effects and development of drug-resistant microorganisms (Leuthner & Doern, 2013). Therefore, a behavioral change is encouraged to enable the doctors to come up with a schedule they find comfortable. The second objective of changing the behavior of prescribing antibiotics is to slowly introduce a culture that will ensure that the core elements in the antibiotic stewardship program are met. For the program to be successful, the leaders within the clinical staff have to be brought on board, because they are the ones, who are involved in drugs prescription to the patients (Kubin, 2008). It is important to encourage their participation by free will, not as a forced rule, which is the third major objective. The involvement of leaders suggests that changes are their achievement, and therefore, they will try their best to ensure the successful implementation of proper drug administering.


The use of antibiotics has improved the lives of many people and has contributed significantly to advancement in cancer chemotherapy and organ transplantation. The success of antibiotics has resulted in mass use of the drugs, even when it is not necessary. Their indiscriminate application has resulted in microbial resistance against the drugs. In addition, antibiotics have severe side effects, such as Clostridium difficile infections (CDI) (Barlam & Hamilton, 2016). Antibiotic stewardship program has a number of core elements that are necessary for its success, with leadership being the primary one. The people in charge of the program must dedicate and commit themselves to the program by availing any financial or technological resources that are required. These leaders should be held accountable for any action done, as pertains the program. Another core element is the expertise of the prescribers. There should be pharmacist, who would be searching the ways to improve the antibiotic use.

Tracking and reporting the trends in antibiotic resistance is a crucial element of the program, and the main findings will help to foretell the future of medicine and contribute to formulation of better policies. Finally, the program ensures that the clinicians are constantly reminded about the best practices of drug prescription.

Literature review

A study conducted in England indicates that 25% – 68% of the suggested prescriptions do not meet the required standards (MacDougall & Polk, 2005). There is a correlation between excess use of antimicrobials, increase in the incidence of Clostridium difficile infections, and the rise of bacteria with drug-resistance mechanisms. In a bid to offer better prescriptions, there is a need to focus on modifying the behavior of the prescribers.

The first step is to study the norms in the hospital environment with regard to administering antibiotics. In this research, the intentions of a particular behavior are determined, then they are later modified. This study is vital because it leads to understanding, what interferes with the change in the prescription process (Kubin, 2008). The changes will then be made in a way that will not discourage the prescribers from adopting them and instead, boost the chances for attaining better results.

The process of identifying a trait requires understanding of Behavioral Sciences. This field uses psychology and sociology to establish a link between behavior and practice. This approach explains, why a particular trait is prevalent in a hospital environment (Pollack & Srinivasan, 2014). The social marketing approach is used to persuade the group of interest to adopt the health changes. The social marketing primarily entails researching the health practitioners and their behavior. The participants are then categorized according to their attitudes, values, and practices. Finally, a customized intervention is made for each group. However, precautions need to be taken, especially when the social marketing is used with the aim of influencing decisions in acute care unit, because the effectiveness of the applied approach is critical in this case.

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The hospital culture, context, and determinants of behavior have been studied through qualitative and quantitative analysis. The results indicate that these factors have an influence on antibiotic prescription patterns and therefore, they produce a variation at the local, national, and international scope (MacDougall & Polk, 2005). Some of the factors that influence the prescriptions are cultural beliefs of healthcare professionals and patients, the clinics motive to be independent, and socio-economic status of the parties (Pollack & Srinivasan, 2014). The hierarchical structure plays an essential role in forming a prescribing culture in the hospital. For example, in most cases, when the senior staff gives an instruction that is passed down to the junior team, it is implemented without any objection arising. The bureaucracy involved in the change process in hospital is slow and tedious, and therefore, the status quo tends to remain in most cases.

When it comes to acute care, various groups are dependent on the change in behavior on the part of the prescribers. That is why careful research is first conducted on the behavioral intention of the medical practitioners before they are tailored to suit them. The qualitative and quantitative analysis are vital in this process. The quantitative analysis gives evidence for the importance of prevention measures used during surgery, the routine of prescribing, ordering, and delivering the antimicrobials. On the other hand, qualitative analysis provides the perspective of healthcare workers towards antibiotic prescriptions and their readiness to adopt the changes. Qualitative research being conducted on the behavioral changes indicates that the medical authorities have a significant impact on the manner, in which antibiotic prescriptions are administered. They influence the prescription behavior and therefore, have a more substantial effect on the procedure than the policies or guidelines. It is recommended to share the idea with leaders in the medical field and persuade them participate in the implementation before the plan is realized (MacDougall & Polk, 2005).

For research to be comprehensive and accurate, there is a need for using multiple approaches, such as social and communication science, qualitative, and quantitative analysis to make it efficient and implement positive interventions (Barlam & Hamilton, 2016). The systematic reviews of the intervention of using the two studies are crucial, because the research has factual data. The prescriptions are therefore provided with a human aspect, which is of great importance, because its success depends on them. In specific areas, antimicrobial prescribing optimization can be achieved, if evidence-based guidelines with feedback are implemented (Barlam & Hamilton, 2016). However, to bring about an effective and efficient behavioral change, careful research should be strained on the determinants that cause the prescribing behavior.


The use of antibiotics has a positive impact on the healthcare sector. However, their overuse, as well as misuse, has led to some microorganisms becoming drug-resistant, and the patients experiencing adverse side effects. To deal with these issues, healthcare organizations initiated the antibiotic stewardship program that aims to control the use of drugs and ensure maximum benefit from their application. It suggests change in the manner of antibiotics administration. The behavioral change mainly entails persuading the health officials to follow the proper procedures, when giving antibiotics to the patients. The persuasion requires knowledge in the fields of social and communication sciences. Quantitative analysis is then used to gather data, which is later interpreted through qualitative analysis. Various studies have discovered that the opinions of leaders in healthcare sector influence the implementation of change significantly. As a result, they must be persuaded at all cost to participate in the implementation of the behavioral change.

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