Four Moments of Antibiotic Decision Making

Moment 1 occurs when a resident is assessed for a change in status and there is a concern for infection. Sometimes long-term care staff recognize that something is not quite right with the resident but aren’t clear on what is wrong. The person doing the assessment should pause and consider if the changes they are noticing really suggest an infection rather than another cause.

Moment 2 occurs immediately after the decision is made to prescribe antibiotics.

First, what type of infection does the resident have? The resident should have appropriate cultures ordered and obtained before starting antibiotics.

Second, what empiric antibiotics should be started? The prescriber should choose an antibiotic that covers the most likely pathogens

Moment 3 occurs at the time the prescriber writes the order for antibiotics. Make sure the type of infection being treated, such as urinary tract infection or bacterial pneumonia, and an antibiotic stop date written as a calendar date, like October 15, 2020, are included in every order.

Moment 4 occurs every day the resident receives antibiotics. Nurses and prescribers should ask if the resident still needs antibiotics. If so, can an antibiotic with a narrower spectrum or with fewer side effects be used instead? If the resident is getting an intravenous antibiotic, can they get an oral antibiotic instead?