AHRQ Safety Program for Long-term Care: HAIs/CAUTI
How to Avoid the Harms of Antibiotic Overuse
Training Module 4 for Core Team Staff
Current as of July 2015
Learning Objective
Upon completion of this session, participants will be able to:
•
Describe what is a knee-jerk antibiotic response;
•
List two reasons to avoid antibiotic overuse;
•
Explain communication strategies that address antibiotic
alternatives with providers, residents and family member; and
•
Train staff members about the importance of avoiding antibiotic
overuse.
2
Have You Ever Heard This?
Why not just give her
an antibiotic? It
won’t do any harm.
It’s probably the
urine. Needs an
antibiotic.
Turning to antibiotics as a knee-jerk reflex
3
Your Role in Engaging Staff in Antibiotic Stewardship
• The presentation and learning activity for
• Review the video and the
licensed front-line staff focus on harms
accompanying materials before
associate with antibiotic overuse and how
facilitating discussion with your frontto communicate with residents and families
line staff and providers
about antibiotic stewardship
• Share information with all
• Key messages from that training resource
staff/teammates
include:
• Recognize and appreciate staff who
― Reasons antibiotics are not good for the
resident
are already proactive about antibiotic
stewardship
― What antibacterial resistance is
― Communication strategies for speaking with
staff members, residents and families
―CUS
• Your role as leaders and teachers is
vital to the prevention of CAUTIs!
―SBAR
4
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
5
Core Team Tip #1
• Share stories to engage staff
• Overuse of antibiotics is something that needs to change
• Think about changes that you may have seen in health care
– Use of restraints
– Universal catheterization policies
• Use case studies to introduce and highlight key concepts and
ideas
6
Why is Knee-Jerk Antibiotic Use Bad?
Reason 2
It Leads to Bacterial Resistance!
27,000 nursing home
residents have
resistant infections
2 out of 3 nursing home
residents receive at least
one course of antibiotics
annually
250,000 nursing home residents
have infections
1.6 million people live in nursing
homes
The White House
Office of the Press Secretary
http://www.cdc.gov/getsmart/healthcare/learn-from-others/factsheets/nursing-homes.html
FACT SHEET: Obama Administration Releases National
Action Plan to Combat Antibiotic-Resistant Bacteria
March 27, 2015
1. Centers for Medicare and Medicaid Services, Long Term Care Minimum Data Set, Resident profile table as of 05/02/2005. Baltimore.
MD.
2. Loeb, M et.al. Antibiotic use in Ontario facilities that provide chronic care. J Gen Intern Med 2001; 16: 376-383.
3. Centers for Medicare and Medicaid Services, Long Term Care Minimum Data Set, Resident Profile Table as of 05/02/2005. Baltimore,
MD.
4. Centers for Disease Control and Prevention, National Center for Health statistics, 1999 National Nursing Home Survey. Nursing Home
Residents, number, percent distribution, and rate per 10,000, by age at interview, according to sex, race, and region: United States,
1999.
7
Why is Knee-Jerk Antibiotic Use Bad?
Reason 2
Let’s look at the example of Klebsiella pneumonia
Antibiotic
Sensitive (S)
or Resistant
(R)
Antibiotic
Sensitive (S)
or Resistant
(R)
Ampicillin
S
Ampicillin
R
Sulfatrimethoprim
(Septra,
Bactrim)
S
30 years ago
Sulfatrimethoprim
(Septra,
Bactrim)
R
Ciprofloxacin
(Cipro)
S
20 years ago
Antibiotic
Sensitive
(S) or
Resistant
(R)
Ampicillin
R
Sulfa-trimethoprim
(Septra, Bactrim)
R
Ciprofloxacin (Cipro)
R
Cefuroxime
R
Nitrofurantoin
(Macrodantin)
R
Ceftriaxone (Rocephin)
R
Gentamycin
R
Carbapenem
R
Today
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Core Team Tip #3
• Reminding your team of the larger mission that is important
to achieving success
– Better care for individual residents
– Fewer resistant infections at your facility
– Saving antibiotics for the future generations
9
Communicating with Interdisciplinary Team Members,
Residents and Families
10
Engaging Physicians and Clinical Leadership
• Share the evidence-based information
•
When Do You Need An Antibiotic? Brochure
•
CDC: Get Smart About Antibiotics
•
CDC: Fact Sheet—Antibiotic Use in Nursing Homes
•
FDA: Know when Antibiotics Work
• Use the CAUTI Criteria—NHSN Definitions Pocket Cards
• Highlight why unnecessary antibiotics are bad for the resident and how it can lead
to antibiotic resistance
• Discuss alternatives to antibiotics
• CUS to train staff on internal communication strategy
11
CUS
Please use CUS Words
but only when appropriate!
12
Communicating with Residents and Families
• Situation
• Educate residents and families
regarding antibiotic use!
– Highlight realistic side effects
– Promote shared decision-making
• Ensure that residents’ needs
for pain relief and other
supportive care are met
• Use SBAR to improve
communication
– 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
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Summary: Avoid Knee-Jerk Antibiotics
• Unnecessary antibiotic use can lead to:
– Resident harms
– An Increase in antibiotic resistant organisms
• Be aware of overuse in these situations:
– Positive urine dipstick
– Positive urine culture
• Communication can reduce antibiotic
overuse:
– Include the resident and family in discussions
– Use proven communication tools like CUS and
SBAR
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Stay Updated with Useful Resources
1.
AHRQ Safety Program for Long-term Care: HAIs/CAUTI Project Website
Login information
Username: ltcsafety
Password: ltcsafety
2.
TeamSTEPPS® for Long-term Care
3.
When Do You Need An Antibiotic? Brochure
4.
CDC: Get Smart About Antibiotics
5.
CDC: Fact Sheet —Antibiotic Use in Nursing Homes
6.
FDA: Know When Antibiotics Work
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