Antibiotic Stewardship s, Hand Hygiene

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  • 1.How To Avoid the Harms of Antibiotic Overuse Training Module 4 AHRQ Pub. No. 16(17)-0003-21-EF March 2017
  • 2.Learning Objective 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. ABX Stewardship │ 2
  • 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 ABX Stewardship │ 3
  • 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! ASB Bacteriuria ≠ CAUTI Bacteriuria means a positive urine culture Bacteriuria is not the same as a catheter-associated urinary tract infection (CAUTI), and vice versa CAUTI ABX Stewardship │ 4
  • 5.Why Is Knee-Jerk Antibiotic Use Bad?Reason 1 IT’S BAD FOR THE RESIDENT! Side effects are common Nausea, diarrhea Allergic reactions Antibiotic-related infections Clostridium difficile Candida (yeast) Wrong diagnosis will delay treatment ABX Stewardship │ 5
  • 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 ABX Stewardship │ 6
  • 7.Bringing the Message Home How is your role important in reducing antibiotic overuse? ABX Stewardship │ 7
  • 8.Engaging Physicians and Other Providers2 Remind others that antibiotic resistance is a growing problem and that antibiotics can have harsh side effects CUS 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! ABX Stewardship │ 8
  • 9.Consider What Residents and FamiliesAre Actually Saying2-5 Situation Explain the current situation Background Brief history with only the important information Assessment Summarize the facts and what you think is going on Recommendation 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 ABX Stewardship │ 9
  • 10.Avoid Knee-Jerk Antibiotics Remember, unnecessary antibiotic use can lead to— Resident harms 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 ABX Stewardship │ 10
  • 11.References The White House, Office of the Press Secretary. National Action Plan for Combating Antibiotic-Resistant Bacteria. March 2015. 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. 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. ABX Stewardship │ 11