Antibiotics Prescribed in EHPAD Retirement Home in Front of Suspition of Urinary Infection Clinical Trial
Official title:
Study 6 Impacts of a Multi-modal Multi-professional Intervention on the Nurse on Antibiotics Prescribing in EHPAD Retirement Home: a Randomized Study in Cluster.
The purpose of this study is to measure the impact of a multimodal intervention through the nurse in relation to prescribers, residents and their families, on antibiotics prescribing for urinary infection in EHPAD Retirement Home
This is a randomized, cluster, two-arm intervention study in 40 EHPAD Retirement Home in
Ile-de-France.
EHPADs Retirement Homes selected for the random draw study will be randomized either to
intervention arm or to control arm. Each time an EHPAD Retirement Home assigned to control
arm is less than 10 km from another intervention arm and vice versa.
This study will consist of four main parts. On the one hand, it will be the inclusion phase
of participating centres prior to the start of the implementation of the intervention. THis
step is planned for one and half months. On the other hand, it is a question to test an
initial intervention for adjustment if necessary for 15 days.
Intervention period will include a period of visits to EHPAD Retirement Home with a phone
follow-up, this phase will last 6 months.
EHPADs Retirement Homes will be invited to build tools to complement those made available by
the research team through an inter-EHPAD Retirement Home of intervention arm. This
competition will start 2 months after the collection phase; that is during the follow-up and
is planned to last 4 months. A further 6 month phase without an EHPAD Retirement Home visit
will then be implemented to observe the autonomy of centres to appropriate and use tools. The
collection of post-intervention data will take place within one month; that's a period of
thirteen months for monitoring and data collection.
The intervention will focus on strengthening the nurse's theoretical knowledge, with online
training, and on the other hand, telephone interviews associated with the reinforcement of
his clinical reasoning through a flowchart of clinical decision support (decision tree).
Another aspect of this intervention will be the strengthening of physician-nurse
communication tools in the relevant EHPADs Retirement Home through the
Situation-Background-Assessment-Recommendation (SBAR).
There are three key moments in the response in addition to the EHPAD Retirement Home
call-back visits:
- Dematerialized training through access to training tools followed by self-assessments.
These tools will focus on antibiotic therapy, urinary tract infection and communication
with nursing physicians.
- A competition between the EHPADs Retirement Home of intervention arm
- The implementation of this intervention, a pre-test will be carried out in two randomly
selected EHPADs Retirement Home which will agree to participate. It will be used to
correct any deficiencies before the actual implementation. Two EHPADs Retirement Home
selected will not be part of the final intervention.
During this study, the following data will be collected by questionnaires: EHPAD Retirement
Home data, infection information, prescription counts and overall consumption per class of
antibiotics, evaluation of the use of information and training tools in EHPADs Retirement
Home of intervention arm (process audit), and improvement of nurses' knowledge (results
audit), all data that will contribute to the medico-economic analysis of the intervention.
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