Understanding and mapping the antibiotic prescribing and administration process in assisted living facilities

Objective

Inappropriate prescribing practices significantly contribute to antibiotic resistance which poses a significant public health challenge. While antibiotic prescribing and administration process has been widely studied in various settings including nursing homes, little is known about Assisted Living Facilities (ALFs). This study aims to map the antibiotic prescribing and administration processes in ALFs.

Design

A qualitative descriptive study using the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model.

Methods

Seven semi-structured interviews were conducted with staff from five ALFs located in a mid-western state. Participating staff were either involved in or knowledgeable about the process. The interviews were analyzed in NVivo using SEIPS 2.0 model as a theoretical framework.

Results

The analysis informed the mapping of a 33-step antibiotic prescribing and administration process for residents in ALFs. They were grouped into five sections: admission, resident having a change in condition, antibiotic prescribing, obtaining the prescription from the pharmacy, and antibiotic administration and follow-up. Pharmacies played critical role in delivery of prescriptions to ALFs and are uniquely positioned to support antibiotic stewardship efforts.

Conclusions and implications

This study is among the first to systematically map the antibiotic prescribing and administration process in ALFs. Insights gathered regarding the use of preferred pharmacies highlight opportunities for pharmacists in stewardship practices. Comparison of the process to that of nursing homes, suggests that several pharmacist-led stewardship interventions used there could be adapted effectively in ALFs. Further research is essential to assess the impact of antibiotic prescribing and pharmacist-driven stewardship interventions tailored specifically for ALFs.