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Table 2 Key elements of the RACF AMS ENGAGEMENT bundle

From: A multimodal intervention to optimise antimicrobial use in residential aged care facilities (ENGAGEMENT): protocol for a stepped-wedge cluster randomised trial

Intervention components

Activities

Delivery and phase

Education and engagement of

(a) GPs and pharmacists

(b) Nurses

(c) Residents and their families

Develop information packages on

(a) Antibiotic choice and duration

(b) Indications for specimen collection, notification of infection-related symptoms to GPs and microbiological testing as clinically indicated

(c) Hazards of inappropriate use for RACF residents and families

A 4-week course for RACF nurses with a primary focus on treatment of suspected UTIs.

Brochures and posters for residents and families. Academic detailing with GPs.

Induction to be implemented during the transition period from control to intervention (online-only delivery possible if required)

Maintenance materials for refresher training and/or new employees available during intervention

Nursing initiatives to enable seamless delivery of the trial

Establish a dedicated telehealth portal (using messaging and telephone communication) to enable RACF nurses to communicate with a researcher team member (on an as-needs basis) with regard to any aspect of the trial.

Phone, email and BlackBoard Web Platform®—using online discussion forums to communicate with an expert member of the research team.

Induction and maintenance

Guideline development specific to antibiotic use in RACF residents

Evidence-based resident-specific clinical pathways and antimicrobial guidelines will be collaboratively developed with input from emergency clinicians, infectious diseases/microbiologists, geriatricians and general practitioners

State guidelines will be tailored to RACFs based on knowledge of local practices, reviewed annually.

Induction and maintenance

Antimicrobial stewardship team creation in RACFs

Establish an AMS team at each facility. The composition of this team will include the clinical nursing director of the RACF, infection control nurse, a key GP working in the RACF, a pharmacist from the pharmacy providing quality use of medicine services to the RACF and an antimicrobial steward.

Oversee the stewardship process, review of the antibiotic guidelines for the RACF, review of the suite of interventions which are part of package and review of outcomes. Members of research team will participate in the first two AMS meetings to build capacity.

Induction and maintenance

Emergency department liaison and promotion of state-wide clinical pathways to ensure consistency of practice across the care continuum

Establishment of an ED liaison to ensure continuity of AMS practices across health care settings

RACF staff to communicate with an ED liaison via phone and /or a letter informing them of the resident’s participation in the trial and key goals of AMS ENGAGEMENT

Induction and maintenance

Electronic decision support to guide RACF urine testing and GP antibiotic prescribing

Access to mobile technology that provides decision support to underpin antibiotic use among RACF residents.

Access to QH Management of Acute Care Needs of RACF residents Guidelines App to help with diagnosis and prescribing and decision-making.

Induction and maintenance

Telehealth support for key intervention components

Quarterly webinars with an expert panel on key issues related to AMS and/or practice changes in RACFs

Telehealth to support case discussions, and for education and training. AMS team and expert panel from research team to act as a panel with three monthly teaching sessions and case-based discussion open to all RACF-registered nurses and GPs in the intervention period

Induction and maintenance

  1. AMS antimicrobial stewardship, GP general practitioner, QH Queensland Health, RACFs residential aged care facilities, UTI urinary tract infection