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Office Hour Synopsis

9/19/17 Office Hour

Hosted by Jeff West (WA) and Brent Schneider (ID) of Qualis Health with special guests Marisa D’Angeli and Patty Montgomery of WA State Department of Health. Register for Next Call October 11th.

Facility-Specific Algorithms for Treatment of Infections
An effective antibiotic stewardship program has antibiotic regimens for specific types of infections and pathogens based on evidenced-based guidelines tailored to meet local conditions. Consulting pharmacists can help nursing homes develop facility specific antibiotic regimens for common infectious conditions.

Resources

 

Antibiograms
Antibiograms show the pattern of bacterial resistance to antibiotics for a specific patient population. This helps prescribers choose more effective antibiotics for empiric treatment before culture and sensitivity results are available. Ideally, a nursing home has access to an antibiogram that reflects the population they serve, based upon culture and sensitivity reports from their own facility or from a group of geographically proximate nursing homes.  As a second best option, a nursing home may make use of an antibiogram from a closely related acute care facility. See resources.

Leadership Support for Antibiotic Stewardship
Obtaining leadership support for antibiotic stewardship programs is crucial in nursing homes. For example, it may be necessary to involve the medical director or consultant pharmacistin providing peer to peer feedback/education to doctors on antibiotic prescribing. Support for antibiotic stewardship should be part of the job descriptions for organizational leaders including the administrator, medical director, consulting pharmacist, and director of nursing.

Resources:  

Qualis Health’s Antibiotic Commitment poster

Qualis Health’s AMS accountability grid

 

Question from Participant: What to do about skin-fold fungal infections that do not meet McGeer criteria because culture is not obtained and rash is not seen by physician for diagnosis (telephone order obtained for treatment.)?

Response: If skin fold rash is characteristic of fungal infection and is causing discomfort, it is reasonable to treat empirically, but a physician diagnosis is important to obtain.  It may be possible to share a photo of the rash with off-site physician for diagnosis or ensure that rash is seen at the next possible opportunity by a physician or ARNP.

Sharing from Participant: “We had off-site physician who ordered antibiotic for asymptomatic bacteremic  UTI  (ABUTI)for a resident with a catheter … we were able to get a stop to that  order and educate  the physician, but this happens a lot when residents go out for appointments.”