1.How To Avoid the Harms of Antibiotic Overuse
Training Module 4
AHRQ Pub. No. 16(17)-0003-21-EF
Upon completion of this session, long-term care staff will be able to—
describe what a knee-jerk antibiotic response is;
list two reasons to avoid antibiotic overuse; and
demonstrate communication strategies that address antibiotic alternatives with providers, residents, and family members.
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3.Have You Ever Heard This?
Why not just give her an antibiotic? It won’t do any harm.
Probably the urine. Needs an antibiotic.
Turning to antibiotics as a knee-jerk reflex
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4.Asymptomatic Bacteriuria (ASB) Versus CAUTI
If you suspect that a resident has a CAUTI, ask yourself two easy questions:
Does the resident have one or more CAUTI signs or symptoms?
Is there another explanation for this resident’s symptoms?
Think before you reach for antibiotics!
Bacteriuria ≠ CAUTI
Bacteriuria means a positive urine culture
Bacteriuria is not the same as a catheter-associated urinary tract infection (CAUTI), and vice versa
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5.Why Is Knee-Jerk Antibiotic Use Bad?Reason 1
IT’S BAD FOR THE RESIDENT!
Side effects are common
Wrong diagnosis will delay treatment
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6.Why Is Knee-Jerk Antibiotic Use Bad?Reason 21
Antibiotic resistance is a growing problem
Often forced to use older antibiotics to deal with resistant organisms
Many of these drugs are harmful to older people
It Leads to Bacterial Resistance!
The White House
Office of the Press Secretary
Fact sheet about National Action Plan to Combat Antibiotic-Resistant Bacteria
March 27, 2015
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7.Bringing the Message Home
How is your role important in reducing antibiotic overuse?
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8.Engaging Physicians and Other Providers2
Remind others that antibiotic resistance is a growing problem and that antibiotics can have harsh side effects
Advocate for individual residents
“I know you don’t want to miss anything with Mrs. Lacy.”
“We learned that cloudy urine is not a symptom of CAUTI. Almost everyone with a catheter gets cloudy urine eventually.”
“Extra urine cultures lead to extra antibiotics—and that’s not good for anyone.”
Please use CUS words,but only when appropriate!
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9.Consider What Residents and FamiliesAre Actually Saying2-5
Explain the current situation
Brief history with only the important information
Summarize the facts and what you think is going on
Explain what actions you think should take place
Family says: “My Bobby always looks like this when he has a UTI.”
We are going to watch him closely.
Let’s help him drink more fluids. Would you be able to encourage him to drink some extra juice?
Family says: “Let’s just give him antibiotics just in case.”
Antibiotics won’t help if he doesn’t have a UTI.
Antibiotics could hurt him (e.g., diarrhea).
We don’t want to miss the real cause.
Educate residents and families regarding antibiotic use!
Ensure that residents’ needs for pain relief and other supportive care are met.
Example Family Dialogue
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10.Avoid Knee-Jerk Antibiotics
Remember, unnecessary antibiotic use can lead to—
An increase in antibiotic resistant organisms
Be aware of overuse if the resident has a positive urine culture; instead, try other treatment options
Communication can reduce antibiotic overuse
Include the resident and family in discussions
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The White House, Office of the Press Secretary. National Action Plan for Combating Antibiotic-Resistant Bacteria. March 2015. https://www.whitehouse.gov/the-press-office/2015/03/27/fact-sheet-obama-administration-releases-national-action-plan-combat-ant. Accessed December 23, 2015.
Appendix. Example of the SBAR and CUS Tools. In: Taylor SL, Saliba D. Improving Patient Safety in Long-Term Care Facilities, Student Workbook. Module 2: Communicating a Change in a Resident’s Condition. Rockville, MD: Agency for Healthcare Research and Quality; June 2012. http://www.ahrq.gov/professionals/systems/long-term-care/resources/facilities/ptsafety/ltcmod2ap.html. Accessed on April 26, 2016.
Varonen H, Sainio S. Patients’ and physicians’ views on the management of acute maxillary sinusitis. Scand J Prim Health Care. 2004 Mar;22(1):22-6. PMID: 15119516.
Van Driel ML, De Sutter, AD, Deveugele M, et al. Are sore throat patients who hope for antibiotics actually asking for pain relief? Ann Fam Med. 2006 Nov-Dec;4(6):494-9. PMID: 17148626.
Braun BL, Fowles JB. Characteristics and experiences of parents and adults who want antibiotics for cold symptoms. Arch Fam Med. 2000 Jul;9(7):589-95. PMID: 10910304.
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