Effect of a Standard vs Enhanced Implementation Strategy to Improve Antibiotic Prescribing in Nursing Homes

Abstract

Key Points Question Does external facilitation improve adoption and effects of a complex antibiotic stewardship intervention in nursing homes? Findings This trial protocol describes a cluster-randomized hybrid type 2 effectiveness-implementation clinical trial of implementation of a multicomponent toolkit focused on improving the recognition and management of suspected urinary tract infection (UTI) in nursing homes. The trial seeks to evaluate whether delivery of external facilitation—coaching, collaborative learning, and peer comparison feedback—to implement this toolkit results in higher rates of toolkit adoption and reduced rates of urine testing and initiation of antibiotics for treatment of suspected UTI. Meaning If successful, external facilitation could become an effective approach for improving spread and adoption of antibiotic stewardship interventions, as well as other quality improvement initiatives, in the nursing home setting.