A Multimodal Intervention to Optimise Antimicrobial Use in Residential Aged Care Facilities (ENGAGEMENT Study)
NCT ID: NCT04705259
Last Updated: 2021-10-14
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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UNKNOWN
NA
18 participants
INTERVENTIONAL
2021-10-01
2022-12-24
Brief Summary
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Detailed Description
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METHODS AND ANALYSIS This study will be conducted using a stepped-wedge cluster randomised trial that will recruit 18 RACFs (each RACF will be considered as one cluster), over a 20 month observation period. Initially an antimicrobial stewardship needs assessment toolkit will be piloted in seven RACFs from different service providers. This will enable the refinement and targeted implementation of the intervention bundle, based on existing requirement of facilities. A multimodal multi-disciplinary set of interventions, the 'ENGAGEMENT bundle', will be tailored to the needs of facilities. This bundle will be implemented as part of the stepped wedge randomised control trial. The key elements of the intervention bundle include education for nurses and general practitioners, telehealth support and formation of an antimicrobial stewardship team. Prior to the sequential introduction of the intervention, each site will act as its own control, in relation to usual care processes for antibiotic use and stewardship.
The primary outcome for this study will be antibiotic consumption measured using defined daily doses (DDDs). Cluster-level rates will be calculated using total occupied bed numbers within each RACF during the post-randomisation observation period as the denominator. Results will be expressed as rates per 1000 occupied bed days. An economic analysis will be conducted to compare the costs associated with the intervention to that of usual care.
Conditions
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Study Design
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RANDOMIZED
SEQUENTIAL
HEALTH_SERVICES_RESEARCH
NONE
Study Groups
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ENGAGEMENT bundle
A multimodal bundle of interventions to optimise antibiotic prescribing in residential aged care facilities. The bundle includes education for nurses and general practitioners caring for residents, telehealth support and implementation of state-wide guidelines.
Antimicrobial Stewardship ENGAGEMENT bundle
Given that a single intervention is unlikely to be effective in stewardship programs, nor in care improvement processes at RACFs \[7\], this trial will deliver a set of multimodal, multidisciplinary interventions to optimise antibiotic use in RACFs. This RACF AMS ENGAGEMENT bundle will comprise the following key interventions:
* Education and engagement of prescribers, nurses, pharmacists and residents and family members
* Nursing initiatives to improve UTI diagnosis and reduce inappropriate urine testing
* Guideline development specific to antibiotic use in RACF residents
* Antimicrobial stewardship team creation in RACF with GP involvement
* EMergency department liaison and use of clinical pathways to ensure consistency of practice across the care continuum
* ElectroNic decision support to guide RACF urine testing and GP antibiotic prescribing
* Telehealth support for key intervention components
Usual care
Usual facility practices with regards to antibiotic prescribing and review
Antimicrobial Stewardship ENGAGEMENT bundle
Given that a single intervention is unlikely to be effective in stewardship programs, nor in care improvement processes at RACFs \[7\], this trial will deliver a set of multimodal, multidisciplinary interventions to optimise antibiotic use in RACFs. This RACF AMS ENGAGEMENT bundle will comprise the following key interventions:
* Education and engagement of prescribers, nurses, pharmacists and residents and family members
* Nursing initiatives to improve UTI diagnosis and reduce inappropriate urine testing
* Guideline development specific to antibiotic use in RACF residents
* Antimicrobial stewardship team creation in RACF with GP involvement
* EMergency department liaison and use of clinical pathways to ensure consistency of practice across the care continuum
* ElectroNic decision support to guide RACF urine testing and GP antibiotic prescribing
* Telehealth support for key intervention components
Interventions
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Antimicrobial Stewardship ENGAGEMENT bundle
Given that a single intervention is unlikely to be effective in stewardship programs, nor in care improvement processes at RACFs \[7\], this trial will deliver a set of multimodal, multidisciplinary interventions to optimise antibiotic use in RACFs. This RACF AMS ENGAGEMENT bundle will comprise the following key interventions:
* Education and engagement of prescribers, nurses, pharmacists and residents and family members
* Nursing initiatives to improve UTI diagnosis and reduce inappropriate urine testing
* Guideline development specific to antibiotic use in RACF residents
* Antimicrobial stewardship team creation in RACF with GP involvement
* EMergency department liaison and use of clinical pathways to ensure consistency of practice across the care continuum
* ElectroNic decision support to guide RACF urine testing and GP antibiotic prescribing
* Telehealth support for key intervention components
Eligibility Criteria
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Inclusion Criteria
* RACFs located in South East Queensland, Australia
Exclusion Criteria
* RACFs unable to provide reports for baseline data
ALL
Yes
Sponsors
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National Health and Medical Research Council, Australia
OTHER
The University of Queensland
OTHER
Responsible Party
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Locations
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Bethany Christian Care
Eight Mile Plains, Queensland, Australia
Carinity Aged Care
Mitchelton, Queensland, Australia
Beaumont Care
Rothwell, Queensland, Australia
Vacenti Aged Care
Upper Mount Gravatt, Queensland, Australia
Countries
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Central Contacts
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Facility Contacts
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Tunde Bulman
Role: primary
References
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Falconer N, Paterson DL, Peel N, Welch A, Freeman C, Burkett E, Hubbard R, Comans T, Hanjani LS, Pascoe E, Hawley C, Gray L. A multimodal intervention to optimise antimicrobial use in residential aged care facilities (ENGAGEMENT): protocol for a stepped-wedge cluster randomised trial. Trials. 2022 May 21;23(1):427. doi: 10.1186/s13063-022-06323-8.
Other Identifiers
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2020002193
Identifier Type: -
Identifier Source: org_study_id