AHRQ Safety Program for Long-term Care: HAIs/CAUTIAHRQ 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

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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.

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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

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Your Role in Engaging Staff in Antibiotic Stewardship

• The presentation and learning activity for licensed front-line staff focus on harms associate with antibiotic overuse and how to communicate with residents and families about antibiotic stewardship

• Key messages from that training resource include:

― Reasons antibiotics are not good for the resident

― What antibacterial resistance is

― Communication strategies for speaking with staff members, residents and families

―CUS―SBAR

• Review the video and the accompanying materials before facilitating discussion with your front-line staff and providers

• Share information with all staff/teammates

• Recognize and appreciate staff who are already proactive about antibiotic stewardship

• Your role as leaders and teachers is vital to the prevention of CAUTIs!

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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

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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

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Why is Knee-Jerk Antibiotic Use Bad?Reason 2

It Leads to Bacterial Resistance!

http://www.cdc.gov/getsmart/healthcare/learn-from-others/factsheets/nursing-homes.html1. 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.

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

27,000 nursing home residents have

resistant infections

The White HouseOffice of the Press Secretary

FACT SHEET: Obama Administration Releases National Action Plan to Combat Antibiotic-Resistant Bacteria

March 27, 2015

Why is Knee-Jerk Antibiotic Use Bad?Reason 2

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Antibiotic Sensitive (S) or Resistant

(R)Ampicillin S

Sulfa-trimethoprim (Septra, Bactrim)

S

Antibiotic Sensitive (S) or Resistant

(R)Ampicillin R

Sulfa-trimethoprim (Septra, Bactrim)

R

Ciprofloxacin (Cipro)

S

30 years ago

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

Let’s look at the example of Klebsiella pneumonia

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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

Communicating with Interdisciplinary Team Members,Residents and Families

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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

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CUS

Please use CUS Wordsbut only when appropriate!

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Communicating with Residents and Families

• 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

• 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

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

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1. AHRQ Safety Program for Long-term Care: HAIs/CAUTI Project WebsiteLogin information

Username: ltcsafetyPassword: ltcsafety

2. TeamSTEPPS® for Long-term Care

Stay Updated with Useful Resources

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