Data from: A structured training program for health workers in intravenous treatment with fluids and antibiotics in nursing homes: a modified stepped-wedge cluster-randomised trial to reduce hospital admissions

Objectives: Hospitalization is potentially detrimental to nursing home
patients and resource demanding for the specialist health care. This study
assessed if a brief training program in administrating intravenous fluids
and antibiotics in nursing homes could reduce hospital transfers and
ensure high quality care locally. Design: A pragmatic and modified cluster
randomized stepped-wedge trial with randomization on nursing home level.
Participants: 330 cases in 296 nursing home residents from 30 nursing
homes were included. Cases were patients provided intravenous antibiotics
or intravenous fluids, in nursing home or hospital. Primary outcome was
localization of treatment, secondary outcomes were number of days treated,
days of hospitalization among admitted patients, type of antibiotics used
and 30-day mortality. Intervention: The nursing homes sequentially
received a one-day educational program for the health workers including
theory and practical training in intravenous treatment of dehydration and
infection, run by two skilled nurses. After completing the training
program, the nursing homes had competence to provide intravenous treatment
locally. Results: The intervention had a highly significant effect on
treatment in nursing homes (OR 8.35, 2.08 to 33.6; P<0.01, or RR
2.23, 1.48 to 2.56). The number treated in nursing homes was stable over
time; the number treated in hospital gradually decreased (chi square for
trend P< 0.001). Among patients receiving intravenous antibiotics
in the nursing homes, 50 (46%) died within 30 days, compared to 30 (36%)
treated in the hospital (P=0.19). Among patients receiving intravenous
fluids locally, 21 (19%) died within 30 days, compared to 2 (8%) in the
hospital group (P=0.34). Mortality was associated with reduced
consciousness and elevated c-reactive protein. Conclusions: A brief
educational program delivered to nursing home personnel was feasible and
effective in reducing acute hospital admissions from nursing homes for
treatment of dehydration and infections.