Clinical trial NCT03761043: Nurse Promotion of IV to PO Antimicrobial Conversion
Official title: Fostering Engagement From Nurses in Promoting IV to PO Antimicrobial Conversion: The FERN-IPO Study
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Behavior Change
Bacterial Infections
Keywords: Nurse
Antibiotic step-down
Lead sponsor: Kelowna General Hospital
Sponsor class: OTHER_GOV
First posted: 2018-12-03
Enrollment: 853
Sex: ALL
Minimum age (years): 19
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: CROSSOVER
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: This is a prospective, quasi-experimental, historically controlled study to evaluate if a behavioural change intervention informed by the COM-B model of behaviour change can improve nurses' self-perceived capability, opportunity, and motivation to engage in the assessment of patients who may be appropriate for IV to PO antimicrobial conversion. This study also seeks to determine if this translates into an increase in IV to PO antimicrobial conversion rates in the acute care setting.

Detailed description: Current antimicrobial stewardship guidelines recommend appropriate and timely IV to PO antimicrobial conversion in hospitalized patients. Published rates of IV to PO antimicrobial conversion are consistently below 50% in eligible inpatients. Studies have suggested that nurses may be well positioned to provide a positive influence on prescriber behavior related to antimicrobial IV to PO conversion, however, no published research has evaluated the impact of nurses on antimicrobial IV to PO conversion rates. Published research has described the barriers and enablers to nurse participation in promoting antimicrobial IV to PO conversion using the COM-B model of behaviour change. This quasi-experimental study will evaluate whether determinants of nurse behaviour and their actual behaviour can be changed to increase antimicrobial IV to PO conversion rates in hospitalized patients.

Eligibility criteria: Inclusion Criteria:

* Nineteen years of age or older
* Employed as a RN or LPN at KGH in any capacity (full-time, part-time or casual employee)
* Practicing on a medicine/thoracic surgery ward (4A) or medicine/oncology/respiratory ward (4B)

Exclusion Criteria:

* RNs or LPNs on orientation shifts/training
* RNs or LPNs not engaged in patient care
* Student nurses/nurses in training

Primary outcomes:
measure: IV to PO antimicrobial conversion rate
timeFrame: Six months (three months pre-intervention, three months post-intervention)
Secondary outcomes:
measure: Days of IV therapy prior to conversion to PO antimicrobial
timeFrame: Six months (three months pre-intervention, three months post-intervention)
measure: Nurse perceptions of capability, opportunity and motivation to promote IV to PO antimicrobial conversion
timeFrame: Six months (three months pre-intervention, three months post-intervention)
Other outcomes:
measure: Balancing measure - Failed IV to PO antimicrobial conversion
timeFrame: Six months (three months pre-intervention, three months post-intervention
measure: Subgroup Analysis 1: Nursing Unit Conversion Comparison
timeFrame: Six months (three months pre-intervention, three months post-intervention)
measure: Subgroup Analysis 2: High Bioavailability Antimicrobial Conversion
timeFrame: Six months (three months pre-intervention, three months post-intervention)
measure: Subgroup Analysis 2: Non-High Bioavailability Antimicrobial Conversion
timeFrame: Six months (three months pre-intervention, three months post-intervention)
Locations:
city: Kelowna
country: Canada
facility: Kelowna General Hospital
state: British Columbia
Study officials:
affiliation: Interior Health Authority
name: Victoria Cox, PharmD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Fisher CC, Cox VC, Gorman SK, Lesko N, Holdsworth K, Delaney N, McKenna C. A theory-informed assessment of the barriers and facilitators to nurse-driven antimicrobial stewardship. Am J Infect Control. 2018 Dec;46(12):1365-1369. doi: 10.1016/j.ajic.2018.05.020. Epub 2018 Aug 1.