How To Avoid the Harms of Antibiotic Overuse

AHRQ Safety Program for Long-Term Care: HAIs/CAUTI

Slide 1: How To Avoid the Harms of Antibiotic Overuse

Text Description is below the image.

Training Module 4

Slide 2: Learning Objective

Text Description is below the image.

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?

Text Description is below the image.

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

Text Description is below the image.

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

Text Description is below the image.

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

Text Description is below the image.

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 "Fact Sheet: Obama Administration Releases National Action Plan to Combat Antibiotic-Resistant Bacteria." Released on March 27 2015.

1. The White House, Office of the Press Secretary. National Action Plan for Combatting Antibiotic-Resistant Bacteria. March 2015. Accessed December 23, 2015.

Slide 7: Bringing the Message Home

Text Description is below the image.

How is your role important in reducing antibiotic overuse?

Slide 8: Engaging Physicians and Other Providers2

Text Description is below the image.

  • 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. Module 2: Communicating a Change in a Resident's Condition. Rockville, MD: Agency for Healthcare Research and Quality; June 2012. Accessed on April 26, 2016.

Slide 9: Consider What Residents and Families Are Actually Saying2-5

Text Description is below the image.

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. Module 2: Communicating a Change in a Resident's Condition. Rockville, MD: Agency for Healthcare Research and Quality; 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

Text Description is below the image.

  • 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

Text Description is below the image.

  1. The White House, Office of the Press Secretary. National Action Plan for Combatting Antibiotic-Resistant Bacteria. 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. Module 2: Communicating a Change in a Resident's Condition. Rockville, MD: Agency for Healthcare Research and Quality; 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.
Page last reviewed April 2017
Page originally created March 2017
Internet Citation: How To Avoid the Harms of Antibiotic Overuse. Content last reviewed April 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/implementaion/education-bundles/urine-culturing/antibiotic-stewardship/part1-slides.html