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Office Hour Synopsis

9/6/17 Office Hour

Hosted by Jeff West (WA) and Brent Schneider (ID) of Qualis Health with special guest Dr. Marisa D’Angeli of WA State Department of Health. Next call Tuesday, September 19 .

Comment:Starting an antibiotic stewardship program can seem overwhelming, especially for smaller, rural, long-term-care communities.

Response: Nursing homes are advised to complete a gap analysis (using the CDC Checklist) and start with higher priority and easier to achieve elements.

  • Obtaining Leadership Support is a priority
  • Demonstrate leadership support easily and publicly using Qualis Health’s Antibiotic Commitment poster
  • Some basic P & Ps are high priority, such as:
    • All antibiotic orders should include at minimum a dose, route, duration of treatment, and the specific reason for the antibiotic (i.e. the indication)
    • A review process to assess new antibiotic orders after 48-72 hours to ensure orders are appropriately adjusted to match 1) culture and sensitivity results and 2) clinical response to treatment (see our example Antibiotic Time-Out Policy )

Comment: SNF patients may return from outpatient specialists visits (e.g. surgeon or oncologists) with an antibiotic order that has no indication and no order for culture and sensitivity… what can be done?

Response: If the SNF has a P&P requiring certain minimum standards for antibiotic orders (see above), the SNF can refer to their P&P when requesting clarification of the order. Prescriber education, in the form of performance feedback, is also a recommended element for Antibiotic Stewardship Programs. When new antibiotics are ordered without a culture and sensitivity, it is still best practice to review the order after 48-72 hours to see if 1) infection is responding to antibiotic, 2) patient is tolerating antibiotic, and 3) if antibiotic can be discontinued or changed to a less broad spectrum alternative.

Comment: Our medical director really likes for us to use a SBAR type tool that identifies the signs and symptoms of infection when communicating about possible infections.

Response: SBAR tools for the three most common classes of infection are available.

Teams are encouraged to visit the WA DOH website for training materials, recorded webinars, “Jump Start Stewardship” and “Ask a Mentor” Q&A link. The next EQuIP for LTC webinar is scheduled for September 27th … you can register at https://attendee.gotowebinar.com/register/5879017588924100354