Developing evidence-based guidance for assessment of suspected infections in care home residents.

Here is the structured PICO analysis for the thirty-fifth article you uploaded:

✅

Full Title (verbatim and exact):

“Developing evidence-based guidance for assessment of suspected infections in care home residents”

Hughes C, Ellard DR, Campbell A, et al.

BMC Geriatrics (2020); 20:59

DOI: https://doi.org/10.1186/s12877-020-1467-6

📄

Type of Article:

Multi-method development and consensus study (literature review, qualitative interviews, consensus meeting)

🔍

PICO Analysis:

Population:

Older residents of UK care homes (residential and nursing), including those with and without dementia
Care home staff, general practitioners (GPs), geriatricians, microbiologists, and family members of residents participated in the development process
Stakeholders drawn from care homes in Northern Ireland and the West Midlands (England)

Intervention:

Revised decision-making algorithm for the recognition and management of:
- Urinary Tract Infections (UTIs)
- Respiratory Tract Infections (RTIs)
- Skin and Soft Tissue Infections (SSTIs)
The updated tool includes:
1. Initial assessment – non-specific and specific signs of infection
2. Observation phase – with temperature thresholds and symptom review
3. Action phase – based on symptom criteria for escalation (e.g. call GP, monitor)
Also includes supportive care (e.g. fluids, paracetamol, observe), and was designed for use by both nursing and non-nursing staff

Comparator:

The updated algorithm is a refinement of an earlier Canadian tool (Loeb et al., 2005)
The new algorithm was compared against:
- Existing care home practice
- Stakeholder perceptions
- Latest evidence from literature (6 studies included)
No randomised trial or direct comparator intervention was conducted

Outcome:

1. Person-centred outcomes:

Not directly assessed in this development study
Anticipated outcomes include:
- Improved recognition of infection
- Reduced unnecessary antibiotic use
- Better alignment of decisions with resident condition and preferences
- Empowerment of care home staff to confidently escalate concerns

2. Process outcomes:

Strong focus on aligning the algorithm with:
- Current clinical evidence
- Usual practice realities
- Stakeholder (staff, GP, family) perceptions
Staff found that it reflected usual practice, though noted:
- Variability in temperature-taking access (non-nurses often prohibited)
- Difficulties applying symptom criteria in residents with dementia
- Concerns about strict wait times for observation before GP contact

3. Health system outcomes:

Intended system impacts include:
- Reduced inappropriate antibiotic prescribing
- Fewer unnecessary GP calls or ED transfers
- Standardised, evidence-based triage support for infections in aged care
Participants agreed it could improve antimicrobial stewardship when paired with training

Summary Conclusion:

This study developed and refined an evidence-based, UK-contextualised algorithm for care home staff to manage suspected infections (UTI, RTI, SSTI). The algorithm includes a three-step structure (assessment, observation, action) and was built using literature review, stakeholder consensus, and field interviews. It addresses concerns such as dementia-related diagnostic complexity, nurse vs non-nurse skill sets, and real-world application. The tool represents a promising support for antimicrobial stewardship and safer infection recognition in care homes, pending full implementation and outcome evaluation.

12877_2020_Article_1467 (1)Download

Life In The Slower Lane