Nurse Promotion of IV to PO Antimicrobial Conversion (FERN-IPO)

Fostering Engagement From Nurses in Promoting IV to PO Antimicrobial Conversion: The FERN-IPO Study

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.

Study Overview

• Status: Completed
• Conditions: Bacterial Infections; Behavior Change
• Intervention / Treatment: Behavioral: Professional Behavior Change Intervention

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.

• Study Type: Interventional
• Enrollment (Actual): 853
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • British Columbia
    • Kelowna, British Columbia, Canada, V1Y1T2
      • Kelowna General Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 19 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Non-Randomized
• Interventional Model: Crossover Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Pre-Intervention Arm; The nurses will have not been exposed to the behavior change intervention.
Experimental: Post-Intervention Arm; The nurses will have been exposed to the behavior change intervention.	Behavioral: Professional Behavior Change Intervention; IV to PO antimicrobial conversion guidelines for nurses, nurse in-services and internet education sessions, IV to PO antimicrobial conversion health record reminder, endorsement from antimicrobial stewardship program, prescribers, and nurse educators.; Other Names: Reminders; Printed educational materials; Educational meetings; Educational outreach visits; Local opinion leaders

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
IV to PO antimicrobial conversion rate	Incidence of IV to PO antimicrobial conversion (defined as the initiation of a PO antimicrobial within 24 hours of discontinuation of an IV antimicrobial during a single treatment course in a specific patient) before and after behavior change intervention	Six months (three months pre-intervention, three months post-intervention)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Days of IV therapy prior to conversion to PO antimicrobial	For treatment courses that undergo IV to PO antimicrobial conversion, the days of IV antimicrobial therapy prior to PO conversion before and after intervention	Six months (three months pre-intervention, three months post-intervention)
Nurse perceptions of capability, opportunity and motivation to promote IV to PO antimicrobial conversion	Constructs are derived using the Theoretical Domains Framework and assess nurse perceived capability, motivation, and opportunity to promote IV to PO antimicrobial conversion using a 7-point Likert scale (1 - Strongly Disagree, 2 - Disagree, 3- Slightly Disagree, 4 - Neither Agree or Disagree, 5 - Slightly Agree, 6 - Agree, 7- Strongly Agree). The average Likert scale score for each of nine constructs (based on the Theoretical Domains Framework) will be calculated for the pre-intervention period and the post-intervention period. Change in the average Likert score for each construct (question) in the pre-intervention period versus the post-intervention period will be compared for each construct. A higher average Likert score on a construct in the post-intervention period compared to the pre-intervention period indicates improved perceptions about capability, opportunity, or motivation to promote IV to PO antimicrobial conversion.	Six months (three months pre-intervention, three months post-intervention)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Balancing measure - Failed IV to PO antimicrobial conversion	Incidence of failed IV to PO antimicrobial conversion (defined as the re-initiation of an IV antimicrobial within seven days following IV to PO conversion of an antimicrobial during a single treatment course for a specific patient) pre and post-intervention	Six months (three months pre-intervention, three months post-intervention
Subgroup Analysis 1: Nursing Unit Conversion Comparison	Incidence of IV to PO antimicrobial conversion on nursing unit 1 (contains a clinical pharmacist) versus nursing unit 2 (does not contain a clinical pharmacist) pre and post-intervention	Six months (three months pre-intervention, three months post-intervention)
Subgroup Analysis 2: High Bioavailability Antimicrobial Conversion	Incidence of IV to PO antimicrobial conversion for highly bioavailable (F ≥ 80%) antimicrobials pre and post-intervention	Six months (three months pre-intervention, three months post-intervention)
Subgroup Analysis 2: Non-High Bioavailability Antimicrobial Conversion	Incidence of IV to PO antimicrobial conversion for non-highly bioavailable (F < 80%) antimicrobials pre and post-intervention	Six months (three months pre-intervention, three months post-intervention)

Collaborators and Investigators

• Sponsor: Kelowna General Hospital
• Investigators: Principal Investigator: Victoria Cox, PharmD, Interior Health Authority

Publications and helpful links

General Publications

• 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.

Study record dates

Study Major Dates

• Study Start (Actual): January 8, 2019
• Primary Completion (Actual): April 7, 2019
• Study Completion (Actual): April 7, 2019

Study Registration Dates

• First Submitted: November 29, 2018
• First Submitted That Met QC Criteria: November 29, 2018
• First Posted (Actual): December 3, 2018

Study Record Updates

• Last Update Posted (Actual): September 6, 2019
• Last Update Submitted That Met QC Criteria: September 5, 2019
• Last Verified: September 1, 2019

More Information

Terms related to this study

• Keywords: Nurse; Antibiotic step-down
• Additional Relevant MeSH Terms: Infections; Bacterial Infections and Mycoses; Bacterial Infections
• Other Study ID Numbers: IH1803202

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No