A quality improvement intervention to address provider behaviour as it relates to utilisation of CA-MRSA guidelines.

AIMS AND OBJECTIVES: To evaluate the impact of a provider focused quality improvement educational intervention on appropriate prescribing for community associated methicillin-resistant Staphylococcus aureus infection. BACKGROUND: Patient, provider and health system factors contribute to appropriate antibiotic prescription. Achieving appropriate prescribing is critical in decreasing the burden of antibiotic resistance. Knowledge of appropriate prescribing for community associated methicillin-resistant Staphylococcus aureus infection is the first step in shifting prescriber behaviour to evidence-based recommendations. DESIGN: Quality Improvement Project. METHOD: Following a review of best practice guidelines and application of the Stetler Research Utilization model, a brief educational intervention was delivered using voice over PowerPoint. Items in the educational intervention included indications for screening, particularly focusing on the role of watch and wait after culturing for simple abscesses. The intervention was delivered in a for-profit, nonacademic, urgent care setting, and assessed prescribing providers' knowledge and practice. RESULTS: Out of 48 medical doctor, physician assistant and nurse practitioner providers, 18 (37·5%) participated; 12 of the 18 (67%) participants showed an increase in knowledge. Forty three per cent of prescribers' charts demonstrated improved practice through use of the guidelines. Out of 18 prescribers, 44% sent a total of 21 cultures for abscesses. There was no difference in practice behaviours between professional groups. CONCLUSIONS: In spite of the increase in knowledge scores, this improvement in knowledge did not translate in dramatic change in practice, although trends in a positive direction were noted. RELEVANCE TO CLINICAL PRACTICE: This quality improvement project underscores the complexity of changing prescriber behaviour and the need for ongoing interventions.

An evaluation framework for faculty practice.

Faculty practice is promoted in schools of nursing for the purposes of strengthening the clinical expertise of faculty, maintaining clinically relevant curricula, fostering student learning, and generating revenue. For clinical faculty, this practice often provides the foundation for academic scholarship. The integration of this scholarship into the traditional academic triad of education, research, and service has proved difficult. Pohl et al notes, "In promotion and tenure decisions, 68 percent of faculty reported that practice was weighted less than teaching and research in their institutions." There appears to be an inherent tension between the requirements for scholarly faculty practice and the academic missions of schools of nursing. The purpose of this article is to describe a framework for the evaluation of faculty practice at the Johns Hopkins University School Nursing (JHUSON) and the actions taken to align the scholarship of faculty practice with the academic research mission of the School.