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NCT Number: NCT03761043

Nurse Promotion of IV to PO Antimicrobial Conversion

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.

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Key information

Conditions

Behavior Change Bacterial Infections Bacterial Infections and Mycoses Infections

Age range

19 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Kelowna General Hospital

Kelowna, British Columbia, V1Y1T2, Canada

About this study

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.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

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

Treatment and study plan

Professional Behavior Change Intervention

Behavioral

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: Printed educational materials, Educational meetings, Educational outreach visits, Local opinion leaders, Reminders

Primary outcomes

  1. IV to PO antimicrobial conversion rate

    Time frame: Six months (three months pre-intervention, three months post-intervention)

    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

Secondary outcomes

  1. Days of IV therapy prior to conversion to PO antimicrobial

    Time frame: Six months (three months pre-intervention, three months post-intervention)

    For treatment courses that undergo IV to PO antimicrobial conversion, the days of IV antimicrobial therapy prior to PO conversion before and after intervention

  2. Nurse perceptions of capability, opportunity and motivation to promote IV to PO antimicrobial conversion

    Time frame: Six months (three months pre-intervention, three months post-intervention)

    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.

Other outcomes

  1. Balancing measure - Failed IV to PO antimicrobial conversion

    Time frame: Six months (three months pre-intervention, three months post-intervention

    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

  2. Subgroup Analysis 1: Nursing Unit Conversion Comparison

    Time frame: Six months (three months pre-intervention, three months post-intervention)

    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

  3. Subgroup Analysis 2: High Bioavailability Antimicrobial Conversion

    Time frame: Six months (three months pre-intervention, three months post-intervention)

    Incidence of IV to PO antimicrobial conversion for highly bioavailable (F ≥ 80%) antimicrobials pre and post-intervention

  4. Subgroup Analysis 2: Non-High Bioavailability Antimicrobial Conversion

    Time frame: Six months (three months pre-intervention, three months post-intervention)

    Incidence of IV to PO antimicrobial conversion for non-highly bioavailable (F < 80%) antimicrobials pre and post-intervention

Sponsors and collaborators

Lead sponsor

Kelowna General Hospital

Other Gov

Registry information

Official study title

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

Acronym: FERN-IPO

Important dates

Study start
2019
Primary completion
2019
Study completion
2019
First posted
Dec 3, 2018
Registry last updated
Sep 6, 2019

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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