1. Importance of Communication about Antibiotic Use Susanne Salem-Schatz, Sc. D. Collaborative Director Massachusetts Coalition for the Prevention of Medical Errors

2. Communication about medications on transitions of care What “Receivers” Want to Know* ¡ indication ¡ dose ¡ start and end date ¡ date and time of last dose ¡ heads-up re potential adverse effects ¡ pre-admission med list ¡ current active med list ¡ pending lab tests *Adapted From Terrance O’Malley, MD April 25, 2012

3. In your handouts: a good place to start 3

4. Cross-facility teamwork Resources in your facility and partners: ¡ C. difficile prevention partnership collaborative team leaders in hospitals and long term care facilities ¡ STate Action on Avoidable Rehospitalizations (STAAR) team in hospitals and long term care facilities 4

5. Communication about antibiotics with Residents and Families

6. Did you ever have a time when: ¡ You didn’t think antibiotics were the best answer, but you prescribed them (or called the request in to the provider) ¡ What happened? ¡ So what? 6

7. Now what?

8. Hippocrates or Nike? 8

9. Persuasive Communication “Tips” ¡ Provide reassurance ¡ Engage families /residents in conversation ¡ Establish Credibility ¡ Brief Graphic Printed Materials ¡ Offer Practical Alternatives ¡ Keep it simple 9

10. Provide Reassurance ¡ What do you do? 10

11. Establish Credibility ¡ Refer to credible sources of data ¡ Centers for Disease Control (CDC) ¡ Federal Drug Administration (FDA ¡ Published literature ¡ Refer to credible individuals ¡ Their physician or nurse practitioner ¡ If you have changed your thinking share how you changed your mind 11

12. Reference experts to enhance credibility 12

13. Engage in conversation ¡ Put yourself in their shoes ¡ Address common myths ¡ Reference with evidence ¡ Let them know there is a plan, even if antibiotics aren’t the answer. 13

14. The power of caring 14

15. Brief Graphic Printed Materials ¡ Use educational materials to reinforce your points ¡ Point to key messages as you talk 15

16. Practical Alternative? ¡ Watch closely for new symptoms ¡ Increase fluids ¡ Monitor I/0 ¡ Check vital signs more frequently 16

17. Keep it simple ¡ Keep it simple--try to get across only a few major points ¡ Use the power of metaphor ¡ Give yourself a script / practice 17

18. Next Steps ¡ TODAY : Practice ¡ AT WORK: ¡ Share with your colleagues (MD/NP, RN) ¡ Think small tests of change ¡ Try it, tweak it, try it again, share and expand ¡ Make notes for your script, your pamphlet TELL US WHAT HAPPENED ¡ Let’s learn together. ¡ What did you change? ¡ What worked best 18

19. Time to Practice You are: The daughter of a resident at the Pleasant Valley skilled nursing facility. You notice that your mother’s behavior is a little “off” and think it is probably because of a UTI (she has had them before) OR The nurse making rounds at the beginning of the evening shift. This resident had been discussed at the change of shift report. Mild mental status changes, weakness, fatigue, and general malaise were observed with no no symptoms of UTI 19

20. Upcoming Events May 16 (if you have colleagues who couldn’t attend today)  April 30 th 8AM-Noon, Newton MA  Repeated May 16 8AM-Noon, Sturbridge MA  Ask the expert  Focus on Diagnosis and Treating UTI  Communication strategies to promote appropriate medication use June 22 nd C. Difficile Prevention Partnership Collaborative Learning and Sharing Workshop  Learn additional strategies for C. diff prevention from local and national experts, and your Massachusetts colleagues. Contact Fiona Roberts froberts@macoalition.org 20