ATOUM 6: does a multimodal intervention involving nurses reduce the use of antibiotics in French nursing homes?: A protocol for a cluster randomized study

INTRODUCTION: Urinary tract infection (UTI) is common in elderly living in nursing homes, and antibiotics prescription for this infection is particularly challenging. In these facilities, due to the absence of on-site physicians, nurses play an essential role when an infection is suspected, as they are the ones who collect and communicate by phone all the information needed by the physician for the decision-making process. In that context, our study aims to reduce antibiotic consumption in nursing homes, using a multimodal intervention, by strengthening nurses’ involvement during the process of prescription for UTI. METHODS/DESIGN: This is a planned 2-arm cluster randomized study of 40 nursing homes randomly assigned either to the control group or to the intervention group, using a 1:1 ratio. The intervention consists of reinforcing the nurses’ knowledge concerning antibiotics and UTI; assist their clinical judgment using a decision aid diagram; improving their communication skills with the residents, their relatives, and the prescribers; and also increasing their involvement in the intervention’ process by organizing a competition opposing the nursing homes of the interventional group to select additional intervention tools. ANALYSIS: The main outcome is the reduction of the relative frequency of antibiotics prescription for UTIs in the interventional group. ETHICS AND DISSEMINATION: Ethics approval was obtained from the French Committee for the Protection of Persons (N. 19.01.04/SI CNRIPH 18.12.07.48123). An article including the main outcome will be submitted to a peer review journal.