1. AHRQ 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

2. 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. 2

3. Have You Ever Heard This? 3 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

4. 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! 4

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 5

6. 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 6

7. Why is Knee-Jerk Antibiotic Use Bad? Reason 2 7 It Leads to Bacterial Resistance! http://www.cdc.gov/getsmart/healthcare/learn-from-others/factsheets/nursing-homes.html 1. 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 House Office of the Press Secretary FACT SHEET: Obama Administration Releases National Action Plan to Combat Antibiotic-Resistant Bacteria March 27, 2015

8. Why is Knee-Jerk Antibiotic Use Bad? Reason 2 8 AntibioticSensitive (S) or Resistant (R) AmpicillinS Sulfa- trimethoprim (Septra, Bactrim) S AntibioticSensitive (S) or Resistant (R) AmpicillinR Sulfa- trimethoprim (Septra, Bactrim) R Ciprofloxacin (Cipro) S 30 years ago 20 years ago AntibioticSensitive (S) or Resistant (R) AmpicillinR Sulfa-trimethoprim (Septra, Bactrim) R Ciprofloxacin (Cipro)R CefuroximeR Nitrofurantoin (Macrodantin) R Ceftriaxone (Rocephin)R GentamycinR CarbapenemR Today Let’s look at the example of Klebsiella pneumonia

9. 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 9

10. Communicating with Interdisciplinary Team Members, Residents and Families 10

11. 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 CardsCAUTI 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 11

12. CUS 12 Please use CUS Words but only when appropriate!

13. 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 13 S ituation – Explain the current situation B ackground – Brief history with only the important information A ssessment – Summarize the facts and what you think is going on R ecommendation – Explain what actions you think should take place

14. 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 14

15. Stay Updated with Useful Resources 1. AHRQ Safety Program for Long-term Care: HAIs/CAUTI Project Website AHRQ Safety Program for Long-term Care: HAIs/CAUTI Project Website Login information Username: ltcsafety Password: ltcsafety 2.TeamSTEPPS ® for Long-term CareTeamSTEPPS ® for Long-term Care 15 3.When Do You Need An Antibiotic? BrochureWhen Do You Need An Antibiotic? Brochure 4.CDC: Get Smart About AntibioticsCDC: Get Smart About Antibiotics 5.CDC: Fact Sheet —Antibiotic Use in Nursing HomesCDC: Fact Sheet —Antibiotic Use in Nursing Homes 6.FDA: Know When Antibiotics WorkFDA: Know When Antibiotics Work