Assignment: Accountability Consultation Case Study

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Briefly describe a hypothetical agency that sought your help as a consultant, noting the client population they serve and they types of counseling services they provide.

You have been employed by this agency to develop an ongoing assessment plan that will allow the agency to determine whether the clients are making gains and are satisfied with their treatment. You visit the agency and meet with the counselors and administrators to discuss potential ways to measure treatment gains (using pre- and post-test assessments) as well as client satisfaction.

Provide an outline of a plan that details how you would go about answering the question: “Are clients here getting better?” Make recommendations about the specific information the agency will need to collect and analyze in order to determine whether their clients are getting better. Refer to and cite best practices presented in the readings for this unit.

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Antibiotic Prescribing in Long-Term Care Facilities: A Meta-synthesis of Qualitative Research

Aoife Fleming1 • Colin Bradley2 • Shane Cullinan1 • Stephen Byrne1

Published online: 2 April 2015

� The Author(s) 2015. This article is published with open access at Springerlink.com

Abstract

Objectives The objective of this review was to synthesize

the findings of qualitative studies investigating the factors

influencing antibiotic prescribing in long-term care facilities

(LTCFs). These findings will inform the development of fu-

ture antimicrobial stewardship strategies (AMS) in this setting.

Methods We searched Embase, PubMed, PsycInfo, So-

cial Science Citations Index and Google Scholar for all

qualitative studies investigating health care professionals’

views on antibiotic prescribing in LTCFs. The quality of

the papers was assessed using the Critical Appraisal Skills

Programme (CASP) assessment tool for qualitative re-

search. Thematic synthesis was used to integrate the

emergent themes into an overall analytical theme.

Results The synthesis of eight qualitative studies indi-

cated that health care professionals and administrators have

identified factors that influence antibiotic prescribing in

LTCFs. These factors include variations in knowledge and

practice among health care professionals, and the LTCF

context, which is unique given the complex patient

population and restricted access to doctors and diagnostic

tests. The social factors underpinning the interaction be-

tween nurses, residents’ families and doctors also influence

decision making around antibiotic prescribing. The study

also found that there is an acknowledged need for col-

laborative, evidence-based AMS specific to LTCFs, as

antibiotic prescribing is heavily influenced by factors

unique to this setting.

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