Knowledge Of Best Practices Research Articles

Improving hospital-based point-of-care ultrasound cleaning practices using targeted interventions: a pre\u2013post study

BackgroundPoint-of-care ultrasound (POCUS) devices are becoming more widely used in healthcare and have the potential to act as fomites. The objective of this project was to study the thoroughness of cleaning of POCUS machines before and after a quality improvement initiative. We designed a mixed-methods, pre/post study which took place over the course of one year at a university-affiliated health center. Cleaning rates of four ultrasound machines used by hospital medicine and critical care medicine services were evaluated using fluorescent marking. Interventions targeted physicians’ knowledge of best practices and improved access to cleaning supplies. Pre- and post-intervention cleaning rates were compared using a generalized linear model. The impact of the corona virus disease of 2019 (COVID-19) pandemic on baseline cleaning rates was also evaluated. Physicians’ attitudes and knowledge of cleaning practices were evaluated via unpaired pre/post surveys.ResultsThere was significant improvement in thoroughness of cleaning following intervention (pre 0.62, SE 0.05; post 0.89, SE 0.07), p < 0.0001). There was no difference in baseline cleaning rates before (0.63, SE 0.09) and after (0.61, SE 0.1) the onset of the COVID-19 pandemic (p = 0.78). Post-intervention surveying found improved understanding of guideline-based cleaning practice, better performance on knowledge-based questions, and fewer reported barriers to machine cleaning.ConclusionThoroughness of cleaning of POCUS machines can be improved with practical interventions that target knowledge and access to cleaning supplies.

1644 Trainee Perspective in Sarcoma Care

AimSoft tissue sarcomas (STS) are rare and aggressive tumours. Appropriate multidisciplinary management requires robust knowledge of best practice and understanding of current guidelines. Plastic surgery trainees must therefore be proficient in the assessment, investigation, and treatment of patients with STS. We aimed to evaluate trainee education, confidence, and competence in managing patients with STS.MethodAll plastic surgery trainees in Wales completed an online questionnaire and written assessment. This was designed by the lead for STS and TPD. Formal training, knowledge of national guidelines and excision margins for different types of STS and skin cancer was assessed using short answer questions. A five-point Likert scale was used to assess trainee confidence in STS and skin cancer management and follow-up. Volume and type of teaching in sarcoma and skin cancer was also quantified.ResultsTrainees received less sarcoma training and were less confident in STS assessment and follow-up, in comparison to skin cancer. More senior trainees or those with formal sarcoma training were more confident in skin cancer management (mean confidence rating 4.4 vs 2.2) and performed better in the written assessment of excision margins (mean score 100% vs 61.45%)ConclusionsTrainees receive less training in sarcoma with a significant impact on their competence and confidence in sarcoma care. We believe this is consistent across the United Kingdom as evidenced by just two sarcoma webinars held during the COVID-19 pandemic. Formal national evaluation of sarcoma teaching should be carried out to inform ongoing efforts to improve educational resources on this important topic for trainees.

Experiences of Transgender and Gender Nonbinary Patients in the Emergency Department and Recommendations for Health Care Policy, Education, and Practice.

Transgender and gender nonbinary (trans/NB) individuals face many barriers to accessing health care in the United States due to systemic and clinician discrimination. Such experiences can lead to avoidance or delays in seeking care. These issues are relevant for emergency department (ED) clinicians and staff because trans/NB patients may use the ED in times of crisis. The purpose of this study was to qualitatively explore experiences of trans/NB individuals accessing health care in the ED and provide recommendations for improvements. This study involved semi-structured qualitative interviews with nine trans/NB individuals living in Arkansas about their experiences when visiting local EDs. Interviews revealed four main themes: 1) system and structural issues; 2) interactions with clinicians/staff influence care received; 3) perceptions of clinician knowledge and education about trans/NB health; and 4) impact on future health and health care access. Participants recommended education for current and future ED clinicians and staff to improve knowledge of best practices for trans/NB health care. Recommendations were also made to improve ED policy for inclusive and affirming intake processes, intake forms, and electronic health record (EHR) documentation, including documentation and use of patients' chosen name and pronouns. The negative experiences and discrimination reported by trans/NB patients in ED visits underscores the importance of improving ED clinician knowledge of gender-affirming care practices, ED intake policies and practices, and EHR documentation in EDs.

Providers' Knowledge of Diagnosis and Treatment Best Practices for Acute Myocardial Infarction (AMI): Evidence from India Using Clinical Vignettes

Research ObjectiveCardiovascular diseases (CVDs) are a leading cause of death worldwide, and 80% of CVD deaths occur in low‐ and middle‐income countries (LMICs). The Global Burden of Disease Study estimates that CVDs contribute 28·1% of total deaths in India. Acute Myocardial Infarctions (AMI) make up a large share of these deaths. Early diagnosis and correct treatment of AMI is critical to preventing CVD‐related deaths. This study aims to assess the competence of primary care providers in India to diagnose and treat AMI and examine differences between public and private sector providers.Study DesignWe conducted a cross‐sectional study of healthcare providers' knowledge of diagnosis and treatment for AMI. Data collection took place in Odisha, one of the poorest states in India, from August 2019 to March 2020. Using data from vignette‐based interviews with primary care providers in the public and private sectors, we assessed providers' knowledge of best practices in clinical care. The public sector providers within this study included physicians at government‐run primary health centers, and the private sector providers were engaged in solo‐practice, irrespective of medical qualifications. The vignette‐responses were evaluated against standard treatment guidelines (STGs) for AMI at the primary care level.Population Studied110 primary care providers working in Odisha, India a state with ~47 million people, of which 32.5% earn &lt; $1.90/day and ~ 60% belong to indigenous or vulnerable social groups.Principal FindingsOverall, providers demonstrated low levels of knowledge: only 67.27% diagnosed AMI correctly, and 0% recommended the correct treatment as per STGs. Providers seldom asked key diagnostic questions such as family and medical history (6.36% of cases) and the nature of the chest pain (10.91%) or results from diagnostic tests like ECG and EKG (30%), lipid profile (1.82%), or angiograms (3.64%). Private sector providers showed higher competence in making a correct diagnosis than public providers (difference of 32.73 percentage points). In line with STGs, 82.43% of providers referred AMI cases to hospitals, with more private than public providers making these referrals. 55.41% of providers prescribed at least one correct drug (in combination with unnecessary drugs). More private providers prescribed at least one correct drug than public sector providers. 44.74% of public providers prescribed only unnecessary drugs, without a single medicine recommended for angina.ConclusionsHealthcare providers in Odisha, India, have low levels of knowledge regarding AMI diagnosis and treatment, with public providers showing lower competence than private providers.Implications for Policy or PracticeOur findings indicate strikingly poor quality of care for AMI at the primary care level. The widespread misdiagnosis of AMI, the prescription of unnecessary drugs, and a lack of appropriate referral raise concerns for India's efforts to address rising rates of CVD. Our findings suggest addressing CVD in LMIC contexts is complex and requires improving the baseline knowledge of providers in both public and private sectors; which may be particularly relevant in contexts with little de facto regulation.Primary Funding SourceBill and Melinda Gates Foundation.

Use of lay vaccinators in animal vaccination programmes: A scoping review.

The human resource gap in veterinary sectors, particularly in low-income countries, imposes limitations on the delivery of animal healthcare in hard-to-reach populations. Lay animal health workers have been deployed in these settings to fill the gap though there are mixed views about the benefits of doing this and whether they can deliver services safely. We mapped evidence on the nature and extent of roles assigned to lay animal vaccinators, and identified lessons useful for their future deployment. Following the PRISMA Extension for Scoping Reviews guidelines, we searched seven bibliographic databases for articles published between 1980 and 2021, with the search terms lay OR community-based OR volunteer AND "animal health worker" OR vaccinator*, and applied an a priori exclusion criteria to select studies. From 30 identified studies, lay vaccinators were used by non-government developmental (n = 12, 40%), research (n = 10, 33%) and government (n = 5, 17%) programmes to vaccinate domestic animals. The main reason for using lay vaccinators was to provide access to animal vaccination in the absence of professional veterinarians (n = 12, 40%). Reported positive outcomes of programmes included increased flock and herd sizes and farmer knowledge of best practice (n = 13, 43%); decreased disease transmission, outbreaks and mortality (n = 11, 37%); higher vaccination coverage (10, 33%); non-inferior seroconversion and birth rates among vaccinated herds (n = 3, 10%). The most frequently reported facilitating factor of lay vaccinator programmes was community participation (n = 14, 47%), whilst opposition from professional veterinarians (n = 8, 27%), stakeholders seeking financial gains to detriment of programmes goals (n = 8, 27%) and programming issues (n = 8, 27%) were the most frequently reported barriers. No study reported on cost-effectiveness and we found no record from a low and middle-income country of lay vaccinator programmes being integrated into national veterinary services. Although the majority of included studies reported more benefits and positive perceptions of lay vaccinator programmes than problems and challenges, regularization will ensure the programmes can be designed and implemented to meet the needs of all stakeholders.

Evaluation of a patient and public involvement training programme for researchers at a large biomedical research centre in the UK

ObjectivesTo design, deliver and evaluate a programme of training workshops for biomedical researchers aimed at building confidence and skills in actively involving patients and the public (PPI) in research.DesignA bespoke...

Intimate Partner Violence Standardized Patient Simulation for Nurse Practitioner Students.

Intimate partner violence (IPV) is a serious public health threat in the United States, affecting millions of individuals and families. The American Association of Colleges of Nursing recommends that nursing programs, both baccalaureate and graduate, provide students didactic training and clinical experience in the assessment and management of IPV. Our goal was to expose Psychiatric Mental Health Nurse Practitioner (PMHNP) students and Family Nurse Practitioner (FNP) students to a simulated IPV scenario so they are prepared to respond appropriately to a survivor's disclosure of IPV when they begin clinical practice. We integrated a patient simulation scenario into our PMHNP and FNP curriculum. A combined group of PMHNP and FNP students participated in a simulation in which the standardized patient provided an unlikely explanation for her injuries. If students inquired about abuse, the patient revealed that she had experienced IPV. A pre- and posttest survey was used to evaluate student knowledge gain before and after the participating in the scenario. A Related Samples Wilcoxon Signed Rank Test was used to evaluate the results. Compared with pretest scores, students demonstrated improved confidence in screening for IPV as well as responding to a disclosure of IPV. Simulation provides a method to enhance student knowledge of incidence, risk, and best practices in relation to the screening, assessment and management of IPV.

Twelve-Month Efficacy of an Obesity Prevention Program Targeting Hispanic Families With Preschoolers From Low-Income Backgrounds

ObjectiveAssess effects of an obesity prevention program promoting eating self-regulation and healthy preferences in Hispanic preschool children. DesignRandomized controlled trial with pretest, posttest, 6- and 12-month assessments. Fourteen waves, each lasting 7 weeks. SettingFamilies recruited from Head Start across 2 sites. ParticipantsTwo hundred fifty-five families randomized into prevention (n = 136) or control (n = 119). InterventionPrevention received curriculum; control received no curriculum. Main Outcome Measure(s)Feeding knowledge/practices/styles (parent); body mass index percentile, eating self-regulation, trying new foods, and fruit/vegetable consumption (child). AnalysisMultilevel analyses for nested data (time points within families; families within waves) and multinomial regression. ResultsProgram increased mothers’ repeated presentation of new foods (P < 0.05), measured portion sizes (P < 0.05), child involvement in food preparation (P < 0.001), feeding responsiveness (P < 0.001), knowledge of best feeding practices (P < 0.001), and feeding efficacy (P < 0.05); reduced feeding misconceptions (P < 0.01) and uninvolved feeding (P < 0.01). Effects on child eating behavior were minimal. At 12 months, children in the prevention group were less likely to have overweight (P < 0.05) or obesity (P < 0.05). Conclusions and ImplicationsProgram effects emphasize the importance of feeding approaches in reducing childhood obesity.

Development, Implementation and Evaluation of a Limited English Proficiency Curriculum

<strong>Background:</strong> Sixty percent of U.S. internal medicine (IM) residency directors report their program includes a curriculum focused on the needs of patients with limited English proficiency (LEP). <strong>Objective:</strong> This quality improvement project sought to improve knowledge of best practices for caring for LEP patients by IM residents by implementing an educational curriculum. <strong>Methods:</strong> Residents from three IM residency programs in a large academic health system were surveyed on their perceived LEP education and barriers at the beginning of the 2018–2019 academic year. A LEP curriculum was developed and delivered to interns of one of the programs. These residents were re-surveyed early in the following academic year. <strong>Results:</strong> 118/392 (30%) residents completed the pre-curriculum survey. 35% of respondents reported frustration or stress while caring for LEP patients. 59% of residents reported deferring an interpreter for LEP patients less than half of the time. After implementation of the curriculum, a significantly higher percentage of residents responded they informed patients of LEP services at the beginning of the patient encounter (42% vs. 58%, p = 0.03), used “teach-back” (38% vs. 63%, p = 0.002), and felt confident in their ability to know if the patient understood the interpreter (25% vs. 42%, p = 0.01). There were no significant changes after implementation of the curriculum on the effect of time pressures, deferring of formal interpretation, and use of ad-hoc interpreters. <strong>Conclusions:</strong> A LEP curriculum delivered as a brief workshop for IM residents increased perceived education in caring for LEP patients and heightened awareness of LEP patient rights to formal interpretation.

Barriers and enablers to effective interprofessional teamwork in the operating room: A qualitative study using the Theoretical Domains Framework.

BackgroundEffective teamwork is critical for safe, high-quality care in the operating room (OR); however, teamwork interventions have not consistently resulted in the expected gains for patient safety or surgical culture. In order to optimize OR teamwork in a targeted and evidence-based manner, it is first necessary to conduct a comprehensive, theory-informed assessment of barriers and enablers from an interprofessional perspective.MethodsThis qualitative study was informed by the Theoretical Domains Framework (TDF). Volunteer, purposive and snowball sampling were conducted primarily across four sites in Ontario, Canada and continued until saturation was reached. Interviews were recorded, transcribed, and de-identified. Directed content analysis was conducted in duplicate using the TDF as the initial coding framework. Codes were then refined whereby similar codes were grouped into larger categories of meaning within each TDF domain, resulting in a list of domain-specific barriers and enablers.ResultsA total of 66 OR healthcare professionals participated in the study (19 Registered Nurses, two Registered Practical Nurses, 17 anaesthesiologists, 26 surgeons, two perfusionists). The most frequently identified teamwork enablers included people management, shared definition of teamwork, communication strategies, positive emotions, familiarity with team members, and alignment of teamwork with professional role. The most frequently identified teamwork barriers included others’ personalities, gender, hierarchies, resource issues, lack of knowledge of best practices for teamwork, negative emotions, conflicting norms and perceptions across professions, being unfamiliar with team members, and on-call/night shifts.ConclusionsWe identified key factors influencing OR teamwork from an interprofessional perspective using a theoretically informed and systematic approach. Our findings reveal important targets for future interventions and may ultimately increase their effectiveness. Specifically, achieving optimal teamwork in the OR may require a multi-level intervention that addresses individual, team and systems-level factors with particular attention to complex social and professional hierarchies.

Domesticating circular economy? An enquiry into Norwegian subnational authorities’ process of implementing circularity

ABSTRACT This article focuses on the introduction of the concept of circular economy into a Norwegian context by concentrating on two levels of subnational authorities against the backdrop of the national level. By drawing on recorded qualitative data collected in the region of Trøndelag and Oslo, we deploy the concept of domestication to analyse how the diffusion of CE as a political, future-oriented concept is appropriated, i.e. through symbolic, practical and cognitive dimensions. Additionally, we consider the performativity of the future as a component in the adoption of the concept. Our findings suggest that the adoption of CE at these levels of governments in Norway is an ongoing process where the co-construction of the dimensions happens concurrently. Relating to the future, the national level takes a translative approach and goes after an increased interest and activity by private actors. At the first subnational level, in the case of the Trøndelag county, the public sector operates as a channel between knowledge of best practices and private actors who can mobilise action. Meanwhile, at the third subnational level, we find at the municipality of Trondheim, a public authority that proactively changes specific practices and regulates (or normalizes) the CE through their own means.

Knowledge Based Decision Support System in Steel Industries

Knowledge-based information system (KBIS) is a structure which is based on understanding, which develops approaches to aid people in decision-making and to gain knowledge of best business practices. Anticipations from these approaches are to converse with human beings but the essence and manner of aid given are important issues. DSS i.e Decision Support Systems is a peculiar kind of information system that eases the growth of product designs of viable quality, functional practices and business decision-making. Developing and executing a decision support program for a steel plant is an asking job. Various business functional fields like production and supply chain, product planning, marketing, and finance, which is required to take several censorious decisions. A KBIS clubbed with DSS will be very useful tool for steel industries in decision making. A detailed discussion on the structure of KBIS and DSS is carried out in this paper. A significant portion of this article is dedicated to the execution of KBDSS i.e knowledge based decision support system in steel industries. The article summarizes with the advantages and shortcomings of KBDSS execution.

Beyond the Post: Exploring Equine Operators’ Understanding and Role in Conservation Best Management Practices

The equine industry is an established part of Maryland agriculture with 79,100 equines valued at approximately $714 million in the state; approximately 10% of these animals are housed in one county. Equine operators are a unique demographic in the agricultural realm, because they are not managing land to produce food or fiber and often are employed in other professions unrelated to agriculture. These operators tend to be unaware of land conservation practices and can have a detrimental effect on areas, like the Chesapeake Bay economy and ecosystem, if shared resources are exploited. The purpose of this study was to explore equine operators’ knowledge and connection of conservation best management practices (BMPs) and their role in being a caretaker of the land. The study was informed by the diffusion of innovations theory and gathered data through semi-structured, qualitative interviews. Equine operators in the study were found to use a variety of informational sources, had a high level of adoption of the BMPs they used, and overall, a majority of participants saw their role as caretakers of the land as an important aspect of their environmental actions. Recommendations from this research include improving communication processes to increase the spread of BMPs and adjusting specific infrastructure aspects to improve retention of equine operators practicing conservation efforts. Further research should investigate other niche areas of agriculture that could potentially be struggling with a knowledge deficit of BMPs and communication neglect between conservation offices and audiences.

A systematic literature review of coffee and tea tourism

PurposeThe purpose of this paper is to propose a rigorous methodology to undertake systematic literature reviews for coffee and tea tourism, thereby providing prospects and challenges of developing these niche markets for destinations.Design/methodology/approachThe approach taken in this research is via a systematic literature review on past studies conducted in English related to coffee and tea tourism. In total, 30 articles related to coffee tourism and 33 papers on tea tourism were analysed.FindingsThe research revealed that studies to date are largely fragmented, often using the lens of a coffee or tea tourism context or the perspectives of a single stakeholder such as consumers or producers. Few studies have attempted to undertake interdisciplinary frameworks to study coffee or tea tourism, which this research then documents as future avenues of investigation.Research limitations/implicationsThis study is conducted through the analysis of secondary data published academic material related to coffee and tea tourism in English and would have omitted other relevant resources that have been documented in the realm of other languages. Empirical, quantitative studies conducted based on this systematic literature review can also validate some of the key arguments central to this qualitative piece of work.Practical implicationsThe research synthesises academic literature to date, providing a succinct overview of what is known about coffee and tea tourism based on the dominant themes and frameworks, thereby increasing practical knowledge and awareness of best practices in the field.Originality/valueThis paper contributes to uncovering the scope of coffee and tea tourism literature to date.

Welfare Issues on Israeli Dairy Farms: Attitudes and Awareness of Farm Workers and Veterinary Practitioners.

Simple SummaryAnimal welfare science embraces all factors that might affect the physical and emotional state of the animal, its ability to cope, and its overall quality of life. In recent years, awareness of farm animal welfare has increased among veterinary practitioners—a major professional figure influencing a farm’s routine, farm workers, consumers, and the general public. In particular, the farm worker’s knowledge of animal welfare is an essential component of the rearing system. The aim of this study was to examine attitudes toward and awareness of select animal welfare issues among farm workers and practitioners. A survey was performed based on anonymous questionnaires filled out by dairy farm workers and veterinary practitioners. The results demonstrated that farm workers’ enjoyment of their work is of great importance, as is their cows’ welfare. The survey showed the farm workers’ awareness of their influence on the cow during milking, the effects of stress on milk production, and the possible effect of human behavior on heifers and cows. The main areas where animal welfare might be improved were farmers’ awareness of learning, memory, and pain masking in cattle, and knowledge transfer from veterinary practitioners to the farm workers. The survey answers further emphasized the crucial importance of communication and understanding between farm workers and their practitioners.Attitudes toward practical dairy cow welfare issues were evaluated based on a questionnaire answered by 500 dairy farm workers and 27 veterinary practitioners. Primarily, the effect of demographic characteristics on attitudes toward cattle welfare was tested. Professionally, five themes were identified: effect of welfare awareness on productivity, knowledge of cattle’s senses and social structure, effects of man–animal interactions on milk yield, pain perception and prevention, and knowledge transfer from veterinary practitioners to farm workers. Farms with a higher welfare awareness score also had higher annual milk yield, with an annual mean difference of 1000 L of milk per cow between farms with higher and lower awareness scores. Veterinary practitioners showed high awareness of cows’ social structure, senses, and pain perception. Farm workers were aware of the influence of man–animal interactions during milking and stress effects on milk yield, and the possible effect of man’s behavior on heifers and cows. Practitioners and farm workers had different views regarding pain perception, mostly involving mutilation procedures. All veterinary practitioners advocated the use of pain alleviation in painful procedures, but only some of them instructed the farm workers to administer it. The survey results emphasize the variation in welfare knowledge and practical applications across farms, and the interest of both the animals and their managers to improve applied knowledge of best practice.

Education, training, and knowledge of infection control among endoscopy technicians and nurses

Our survey of 88 endoscopy technicians and nurses to determine their experience, training, and knowledge of infection control found that few personnel (<15%) received formal training in endoscope reprocessing or infection prevention before or after joining an endoscopy unit. While self-reported confidence in endoscope reprocessing was high (9 out of 10), knowledge of best practices in this regard lagged (average assessment score of 62%).

Data literacy and management of research data – a prerequisite for the sharing of research data

PurposeThe purpose of this paper is to investigate the knowledge and attitude about research data management, the use of data management methods and the perceived need for support, in relation to participants’ field of research.Design/methodology/approachThis is a quantitative study. Data were collected by an email survey and sent to 792 academic researchers and doctoral students. Total response rate was 18% (N = 139). The measurement instrument consisted of six sets of questions: about data management plans, the assignment of additional information to research data, about metadata, standard file naming systems, training at data management methods and the storing of research data.FindingsThe main finding is that knowledge about the procedures of data management is limited, and data management is not a normal practice in the researcher's work. They were, however, in general, of the opinion that the university should take the lead by recommending and offering access to the necessary tools of data management. Taken together, the results indicate that there is an urgent need to increase the researcher's understanding of the importance of data management that is based on professional knowledge and to provide them with resources and training that enables them to make effective and productive use of data management methods.Research limitations/implicationsThe survey was sent to all members of the population but not a sample of it. Because of the response rate, the results cannot be generalized to all researchers at the university. Nevertheless, the findings may provide an important understanding about their research data procedures, in particular what characterizes their knowledge about data management and attitude towards it.Practical implicationsAwareness of these issues is essential for information specialists at academic libraries, together with other units within the universities, to be able to design infrastructures and develop services that suit the needs of the research community. The findings can be used, to develop data policies and services, based on professional knowledge of best practices and recognized standards that assist the research community at data management.Originality/valueThe study contributes to the existing literature about research data management by examining the results by participants’ field of research. Recognition of the issues is critical in order for information specialists in collaboration with universities to design relevant infrastructures and services for academics and doctoral students that can promote their research data management.

Structural Analysis of Strigolactone-Related Gene Products.

Structural knowledge of biological macromolecules is essential for understanding their function and for modifying that function by engineering. Protein crystallography is a powerful method for elucidating molecular structures of proteins, but it is essential that the investigator has a basic knowledge of good practices and of the major pitfalls in the technique. Here we describe issues specific for the case of structural studies of strigolactone (SL) receptor structure and function, and in particular the difficulties associated with capturing complexes of SL receptors with the SL hormone ligand in the crystal.

14. Outcomes from the AHRQ Safety Program for Improving Antibiotic Use Across 439 Long-term Care Facilities

BackgroundImplementing effective antibiotic stewardship programs (ASPs) in long-term care (LTC) settings is challenging. We present the results of an intervention intended to change the culture of antibiotic prescribing in 439 United States LTC facilities (LTCF).MethodsThe LTC Safety Program assisted LTCFs with establishing and implementing ASPs from 12/2018 to 11/2019. Through webinars held 1–2 times per month and other educational content, the Safety Program emphasized 1) the science of safety to improve teamwork and identify antibiotic-associated harm and 2) clinical best practices in making antibiotic treatment decisions. Content was organized using the Four Moments of Antibiotic Decision Making Framework (Figure 1). All staff (e.g., physicians, nurses, nurse assistants) were encouraged to participate. LTCFs submitted monthly antibiotic days of therapy (DOT), numbers of new antibiotic starts, urine cultures (UCX) ordered, Clostridioides difficile LabID events, and census data. Generalized linear mixed effects models were used to calculate pre-post intervention changes at bi-monthly intervals for antibiotic DOT, antibiotic starts and UCX, each per 1,000 resident-days (RD), and C. difficile LabID events per 10,000 RD, comparing the beginning (1/2019 and 2/2019) and end (11/2019 and 12/2019) of the Safety Program.Figure 1. Four Moments of Antibiotic Decision Making in the Long-Term Care SettingResultsOf 439 LTCFs who completed the Safety program, the majority were mid-sized (75–149 beds; 229, 52.2%), most were non-hospital based and owned by a larger system (246, 56.0%), with similar distributions between urban and rural settings. Of these, 348 (79%) submitted both baseline and end-of-intervention data. Antibiotic starts decreased from 7.89 to 7.48 starts/1000 RD; P = 0.02). Days of therapy for all antibiotics decreased from 64.1 to 61.0 DOT/1,000 RD; P = 0.068) and for fluoroquinolones (an antibiotic targeted in the Safety Program) from 1.49 to 1.28 DOT/1,000RD; P=0.002. UCX decreased from 3.01 to 2.63 orders/1000 RD; P = 0.001). There were no significant differences in C. difficile LabID events Table 1. Table 1. Changes from baseline (Jan-Feb, 2019) to the end (Nov-Dec, 2019) of the AHRQ Safety Program ConclusionBy targeting both antibiotic prescribing culture and knowledge of best practices, the AHRQ Safety Program led to significant reductions in antibiotic use across a large cohort of LTCFs.Disclosures Morgan Katz, MD, MHS, AHRQ (Research Grant or Support)FutureCare Health Systems (Consultant)Roche (Advisor or Review Panel member) Robin Jump, MD, PhD, Accelerate (Grant/Research Support)Merck (Grant/Research Support)Pfizer (Grant/Research Support, Advisor or Review Panel member)Roche (Advisor or Review Panel member)

Effective and Evidence-Based: How the 4Ms Age-Friendly Framework Can Result in Improved Care in a Rural Primary Care Clinic

As healthcare providers struggle to reframe aging, framing Age-Friendly care is also occurring. The Arkansas Geriatric Education Collaborative (AGEC) is a HRSA Geriatric Workforce Enhancement Program with an objective to improve clinical health outcomes of older adults (OA) in primary care settings. As a member of the 2020 Institute for Healthcare Improvement (IHI) Age-Friendly cohort, the AGEC has partnered with ARcare, an AR federally qualified healthcare clinic network, to implement the 4Ms in 4 rural clinics over 3 years. AGEC’s first goal of working with rural primary care clinics is to improve their knowledge of best practices of caring for OA. This was started by providing Geriatric Interdisciplinary Team Training to clinic staff, obtaining baseline data of common health related indicators for OA and starting regular geriatric focused training. Training on the 4Ms (Matters, Medication, Mentation Mobility) framework was next and completed followed by planning and implementation. The process was well received and results are promising. Year 1 data in one clinic show incremental improvements over baseline data in several areas including assessing Mobility with fall screens which has improved over 50% in one year and annual wellness visits (where all 4Ms are reviewed) have increased 30%. However, several areas of opportunities for improvement have also been noted and turned into quality improvement projects (QI). This includes an opportunity to improve depression screens for the clinic’s Mentation measure, which dropped almost 30% in one year. QI projects are ongoing to improve each of the elements of becoming age-friendly.