Table 3.

Strategies with exemplar quotes that LTCF staff utilize to promote interprofessional communication

Strategy	Exemplar quote
Communication scripts	Q21. The nurses' feedback is much, much more important than mine, because they do it every day. And in the cascade of what happens in antibiotic stewardship program, the nurses themselves are given feedback on how they communicate, because we have very specific, we use very specific communication scripts. (LTCF Medical Director, 113)
Forms for diagnosis of UTIs	Q22. So we have 2 different forms, to be very obvious. This way, the physician doesn't get the wrong idea of what we want. One form says, we evaluated for urinary tract symptoms because of, you know, because of concerns from family, or because of concerns from staff. The following urinary symptoms were found. And then just, you know, there's your McGeer's Criteria, so you can check, you're following urinary symptoms. And then right below that, it says, these symptoms do not meet McGeer's Criteria for urinary tract infection. We recommend watching and pushing fluids. (Director of Nursing, 111)
Facility best practice criteria	Q23. The other feedback that nobody talks about in the literature that I've seen is the communication that the nurse does to the physician about the resident change of condition. Our nurses are encouraged to question the physician about the things they are doing, …. If the doctor wants to get a urine culture to start antibiotic before even the urine culture comes back out, the nurse might say, ‘doctor, this resident doesn't have clinical criteria that I can find that satisfies our facility best practice criteria.’ (LTCF Medical Director, 113)
Nurse-to-nurse education on communication with physicians	Q24. The conversation is the huge piece that I'm trying to get to my nurses is painting the picture for the physician, the things that the patient is exhibiting and then also the things that have not changed, that they're still doing well. And then encouraging them, you know, if they do choose to say, ‘well, let's send them over for [ED] evaluation,’ asking them, ‘you know, what are we wanting [the ED] to evaluate?’ You know, if it's just, if we're gonna go over there, and they're going to draw labs and test their stool or, you know, can we do that here? Or if they just need, you know, hydration, if they just need fluids, we can put an IV in here, and we can, you know, we can start fluids. We can start blood draws. And it's just building the confidence of our nurses. (LTCF Infection Preventionist, 109)
	Q25. The mindset of nurses sometimes is if the doctor's giving an antibiotic well then the doctor's found what's wrong with them and they're taking care of the patient and why should I question anymore. (LTCF Infection Preventionist, 104)
Educating the physician	Q26. The education piece of the nurses is to help them understand, so they know how to educate the doctors. Like if we get a new doctor onboard, or we're calling an on-call doctor, as long as they can present it in the correct way, then there's usually no problems. (LTCF Infection Preventionist, 112)
Developing trust through on site in services	Q27. Oftentimes, I will have one-on-one in services with the nursing staff on the floor, to talk about developing this antibiotic stewardship program. I'll talk to them about identifying signs and symptoms of UTI. (LTCF Medical Director, 116)
Supportive and present medical director	Q28. I think if you don't have a supportive medical director that can help your nurses, you're going to see more ED visits. You're going to see more hospitalizations that are perhaps unnecessary. (LTCF Director of Nursing, 110)