Exploring the Effectiveness of Team-based Enablement Interventions to Improve Antibiotic Prescribing within a Psychiatric Hospital.

Background: Antimicrobial resistance threatens the effective prevention and treatment of many types of infections. Infection occurs more frequently in patients diagnosed with psychiatric illness due to a number of risk factors. Urinary tract infections (UTI) are among the most common infections in this patient population. Currently, there is little information available offering guidance on how to treat infections commonly reported in patients with psychiatric illnesses, nor are there specific recommendations on how to provide efficient and effective educational interventions to prescribers who typically are not infectious disease specialists yet are responsible for treating infections within a psychiatric hospital. This study aims to determine 1) whether psychiatric inpatients were appropriately treated for a urinary tract infection (UTI) prior to educational interventions, and 2) whether there is a relationship between different modes of educational interventions and increased knowledge attainment and retention among healthcare clinicians regarding UTI treatment. This study also sought to determine if 3) health-team teaching used as an enablement method improves antibiotic prescribing and if 4) the number of appropriate UTI treatment regimens increased following educational intervention compared to baseline (prior to educational intervention).
Methods: A 10-question pre-test survey focusing on UTIs was administered to clinicians in various healthcare disciplines who were later randomly assigned to receive UTI educational interventions either as a live lecture or independent study with identical content. The same 10-question survey was administered as a post-test, 6 to 7 weeks following the educational intervention. Antibiotic prescribing prior to and following educational interventions was assessed to note prescribing trends.
Results: Analysis showed that healthcare providers who received live education scored higher on the post-test survey versus those who received directions for self-directed review of educational material presented at the live educational intervention (p<0.001). Following educational interventions, the number of urine samples collected for suspected UTI decreased, resulting in a decrease of unnecessary antibiotic treatment. The number of appropriately prescribed antibiotic treatment regimens increased following educational efforts.
Conclusion: These enablement educational intervention strategies resulted in significantly improved antibiotic prescribing, indicating that andragogical teaching methods, reinforced through printed material and verbal communication of prescribing deficits, promotes knowledge retention and improved care for patients hospitalized with psychiatric illness.

RCT Entities:   Population Interventions Outcomes