Transcript Training Module 4 for All Long-term Care Staff

AHRQ Safety Program for Long-term Care: HAIs/CAUTI
How to Avoid the Harms of Antibiotic
Overuse
Training Module 4 for All Long-term Care Staff
Current as of July 2015
Learning Objective
Upon completion of this session, long-term care staff
will:
• 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.
2
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
3
Asymptomatic Bacteriuria (ASB) vs CAUTI
Bacteriuria ≠ CAUTI
• Bacteriuria means a positive urine
culture
• Bacteriuria is not the same as CAUTI,
and vice versa
ASB
CAUTI
If you suspect that a resident has a
CAUTI, ask yourself 2 easy
questions:
1.
Does the resident have one or more
CAUTI symptoms?
2.
Is there another explanation for this
resident’s symptoms?
Think before you reach for
antibiotics!
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
Why is Knee-Jerk Antibiotic Use Bad?
Reason 2
It Leads to Bacterial Resistance!
• 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 persons
The White House
Office of the Press Secretary
FACT SHEET: Obama Administration Releases National
Action Plan to Combat Antibiotic-Resistant Bacteria
March 27, 2015
6
Bringing The Message Home
How is your role important in reducing
antibiotic overuse?
7
Engaging Physicians and Other Providers
• Remind others that antibiotic resistance is
Please use CUS Words
a growing problem and that antibiotics can
but only when appropriate!
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.”
8
Consider What Residents and Families
are Actually Saying
Educate residents and families regarding antibiotic use!
Ensure that residents’ needs for pain relief and other supportive care are met.
Example Family Dialogue
Family Says: “My Bobby always looks like this when
he has a UTI.”
•
o We are going to watch him closely.
•
o Let’s help him drink more fluids. Would you be
able to encourage him to drink some extra
juice?
– Explain the current situation
o Antibiotics could hurt him (diarrhea).
o We don’t want to miss the real cause.
(Varonen & Sainio, 2004; van Driel et al., 2006; Braun & Fowles, 2000)
Background
– Brief history with only the
important information
•
Family Says: “Let’s just give him antibiotics just in
case.”
o Antibiotics won’t help if he doesn’t have a UTI.
Situation
Assessment
– Summarize the facts and
what you think is going on
•
Recommendation
– Explain what actions you
think should take place
9
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 and instead try other
treatment options
•
Communication can reduce antibiotic overuse:
–
Take the Pledge
Include the resident and family in discussions
10
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.
National Action Plan For Combating Antibiotic-Resistant Bacteria
5.
Office of the Press Secretary Fact Sheet on Combating Antibiotic-Resistant
Bacteria
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