Challenges of antibiotic prescribing for assisted living residents: perspectives of providers, staff, residents, and family members.

OBJECTIVES: To better understand the antibiotic prescribing process in assisted living (AL) communities given the growing rate of antibiotic resistance.
DESIGN: Cross-sectional survey.
SETTING: Four AL communities in North Carolina. PARTICIPANTS: Assisted living residents who received antibiotics (n = 30) from October 20, 2010, to March 31, 2011, a primary family member, staff, and the prescribing medical provider. MEASUREMENTS: Semistructured interviews that were conducted regarding prescribing included the information available at the time of prescribing and the perceptions of the quality of communication between providers, staff, residents and family members about the resident. Providers were asked an open-ended question regarding how to improve the communication process related to antibiotic prescribing for AL residents.
RESULTS: For the 30 residents who received antibiotic prescriptions, providers often had limited information about the case and lacked familiarity with the residents, the residents' families, and staff. They also felt that cases were less severe and less likely to require an antibiotic than did residents, families, and staff. Providers identified several ways to improve the communication process, including better written documentation and staff and family presence.
CONCLUSION: In a small sample of AL communities, providers faced an array of challenges in making antibiotic prescribing decisions. This work confirms the complex nature of antibiotic prescribing in AL communities and indicates that further work is needed to determine how to improve the appropriateness of antibiotic prescribing.