The Big Fight Campaign: Care Homes

Janice Price

Abertawe Bro Morgannwg University Health Board

Project Scope

The care homes project focuses on educating and informing staff in care homes on areas that contribute towards achieving the aim of Big Fight Campaign, including awareness raising of harms caused by inappropriate use of antibiotics, and appropriate identification and management of urinary tract infections in care home residents.

Prior to the Big Fight Campaign there was no dedicated Infection Prevention and Control Nurse (IPCN) resource for primary care and the Abertawe Bro Morgannwg University Health Board (ABMUHB) IPCNs had not provided any training to staff in care homes.

Questions asked prior to training showed that:

  • Few staff understood the risks of increasing antimicrobial resistance;

  • Many staff understood that antimicrobials did not cure all infections;

  • Few staff knew about Clostridium difficile infection (CDi);

  • Many staff thought that residents with a positive “dipstick” should be treated with antibiotics.

Analysis / Problem-Solving Methods / Approach

The care homes were identified and it was decided to undertake face-to-face education rather than an alternative method e.g. E-learning. This was principally to enable the Big Fight Team build relationships and engage with this important stakeholder group.

This also presented an opportunity to better understand training needs of care home staff and align these with the aims of the Big Fight Campaign.

Goals & Targets

The aim was to visit all care homes in ABMUHB at least once in the first year of the Big Fight Campaign in order to:

  • Improve staff knowledge of the risks of inappropriately prescribing antimicrobials including resistance and CDi.

  • Introduce a tool to assist with the correct diagnosis of urinary tract infection including advice on “dipsticking” urine, thereby reducing inappropriate antimicrobial prescribing. The tool is being shared with GPs, primary care nurses and care home staff.

  • Discuss steps to prevent the development of urinary tract infection.

  • Build supporting relationships with care home staff including supporting them when they have patients with CDi.

  • Emphasise the need for flu vaccination.

  • Encourage staff to take messages about antimicrobial resistance and the need to only take antimicrobials when necessary home to their families and friends.

Future State

As of the end of October 2016, 60% of care homes have received training. Following training, the majority of staff

  • Can indicate the reasons for the need for prudent and appropriate prescribing of antimicrobials and the meaning of resistance;

  • Know the symptoms of CDi and how to prevent spread;

  • Know the need to only treat residents who have signs and symptoms of urinary tract infection with antimicrobials; and

  • Know not to “dipstick” urine because it is dark and malodorous.

Following feedback from staff the content and emphasis of the training was modified to meet their training needs.

Interventions/ Actions

A training package was developed in February 2016 by the Big Fight Nurse. The package was piloted initially and amended following responses and feedback from staff.

The revised package was then rolled out to other care homes. Short videos on antibiotic resistance and the need to be vaccinated against flu have been added to the presentation to support the key messages.

Benefit / Impact / Outcomes

  • Established and strengthened Big Fight and IPCN relationships with care home staff.

  • Improved knowledge as evidenced by post session questionnaires.

  • Positive feedback evidenced through post-training evaluations.

  • Self assessments completed by staff also demonstrate that they perceive they have increased knowledge after the training.

  • Identified baseline knowledge amongst staff is variable requiring a flexible training approach.

  • A number of care home staff completed this section during the presentation. Therefore knowledge may be less than indicated above.

  • Analysis has not been completed on all questionnaires completed by staff.

Fit with Prudent Healthcare

The care homes project, as part of the Big Fight campaign, supports prudent healthcare:

  • Correct diagnosis of Urinary Tract Infection (UTI) and appropriate prescribing will reduce the risk of residents receiving unnecessary/inappropriate antimicrobials.

  • Correct diagnosis of UTI using the tool based on evidence will reduce variation and inappropriate practice.

  • Appropriate prescribing will reduce the risk of increasing antimicrobial resistance.

  • Appropriate prescribing will reduce the risk of residents developing CDi.

  • Appropriate prescribing will improve the cost effectiveness of antimicrobial prescribing.

Part of Cohort Bevan Exemplar Projects 2015-16