1. AHRQ Safety Program for Long-term Care: HAIs/CAUTI How to Avoid the Harms of Antibiotic Overuse Training Module 4 for All Long-term Care Staff Current as of July 2015

2. Learning Objective Upon completion of this session, long-term care staff will: 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. 2

3. Have You Ever Heard This? 3 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

4. Asymptomatic Bacteriuria (ASB) vs CAUTI If you suspect that a resident has a CAUTI, ask yourself 2 easy questions: 1.Does the resident have one or more CAUTI symptoms? 2.Is there another explanation for this resident’s symptoms? Think before you reach for antibiotics! 4 ASB Bacteriuria ≠ CAUTI Bacteriuria means a positive urine culture Bacteriuria is not the same as CAUTI, and vice versa CAUTI

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. Why is Knee-Jerk Antibiotic Use Bad? Reason 2 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 persons 6 It Leads to Bacterial Resistance! The White House Office of the Press Secretary FACT SHEET: Obama Administration Releases National Action Plan to Combat Antibiotic-Resistant Bacteria March 27, 2015

7. Bringing The Message Home How is your role important in reducing antibiotic overuse? 7

8. Engaging Physicians and Other Providers 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.” 8 Please use CUS Words but only when appropriate!

9. Consider What Residents and Families are Actually Saying 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 Family Says: “My Bobby always looks like this when he has a UTI.” o We are going to watch him closely. o 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.” o Antibiotics won’t help if he doesn’t have a UTI. o Antibiotics could hurt him (diarrhea). o We don’t want to miss the real cause. 9 (Varonen & Sainio, 2004; van Driel et al., 2006; Braun & Fowles, 2000) Educate residents and families regarding antibiotic use! Ensure that residents’ needs for pain relief and other supportive care are met. Example Family Dialogue

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 and instead try other treatment options Communication can reduce antibiotic overuse: – Include the resident and family in discussions 10 Take the Pledge

11. 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 11 3.When Do You Need An Antibiotic? BrochureWhen Do You Need An Antibiotic? Brochure 4.National Action Plan For Combating Antibiotic-Resistant BacteriaNational Action Plan For Combating Antibiotic-Resistant Bacteria 5.Office of the Press Secretary Fact Sheet on Combating Antibiotic-Resistant BacteriaOffice of the Press Secretary Fact Sheet on Combating Antibiotic-Resistant Bacteria