´óÏóÊÓƵ

Slide 1: How To Avoid the Harms of Antibiotic Overuse

Training Module 4

Slide 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.

Slide 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

Image: Providers reviewing a patient file.

Slide 4: Asymptomatic Bacteriuria (ASB) Versus CAUTI

Bacteriuria ≠ CAUTI

• Bacteriuria means a positive urine culture.
• Bacteriuria is not the same as a catheter-associated urinary tract infection (CAUTI), and vice versa.

If you suspect that a resident has a CAUTI, ask yourself two easy questions:

1. Does the resident have one or more CAUTI signs or symptoms?
2. Is there another explanation for this resident's symptoms?

Think before you reach for antibiotics!

Image: Bacteriuria - Venn diagram illustrating that bacteriuria does not always mean a person has a CAUTI. They could have asysmptomatic bacteriuria.

Slide 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

Slide 6: Why Is Knee-Jerk Antibiotic Use Bad?
Reason 2¹

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 people.

Images: National Action Plan For Combating Antibiotic-Resistant Bacteria - The cover of the National Action Plan For Combating Antibiotic-Resistant Bacteria released in March 2015.
Office of the White House Press Secretary - Office of the White House Press Secretary released " ." Released on March 27 2015.

^1. The White House, Office of the Press Secretary. . March 2015. Accessed December 23, 2015.

Slide 7: Bringing the Message Home

How is your role important in reducing antibiotic overuse?

Slide 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!

Image: CUS Tool Explination -

CUS tool. Start with
"I am concerned..."
Then escilates to "This makes me uncomfortable..." and finally "This is a resident safety issue!"

^2. Appendix. Example of the SBAR and CUS Tools. In: Taylor SL, Saliba D. Improving Patient Safety in Long-Term Care Facilities, Student Workbook. . Rockville, MD: ´óÏóÊÓƵ; June 2012. Accessed on April 26, 2016.

Slide 9: Consider What Residents and Families Are Actually Saying^2-5

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."

• 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.

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

^2. Appendix. Example of the SBAR and CUS Tools. In: Taylor SL, Saliba D. Improving Patient Safety in Long-Term Care Facilities, Student Workbook. . Rockville, MD: ´óÏóÊÓƵ; June 2012. Accessed on April 26, 2016.
^3. 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.
^4. 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.
^5. 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.

Slide 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

Slide 11: References

1. The White House, Office of the Press Secretary. . March 2015. Accessed December 23, 2015.
2. Appendix. Example of the SBAR and CUS Tools. In: Taylor SL, Saliba D. Improving Patient Safety in Long-Term Care Facilities, Student Workbook. . Rockville, MD: ´óÏóÊÓƵ; June 2012. Accessed on April 26, 2016.
3. 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.
4. 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.
5. 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.