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Office Hour Synopsis

October 11, 17 and November 1 Office Hours
Hosted by Jeff West (WA) and Brent Schneider (ID) of Qualis Health

Next call Tuesday November 14th at 11-12 Pacific Time; register here

 

Online Resources

The calls highlighted resources available found at a number of websites:

Please feel free to reach out to Qualis Health if you have any questions or would like any help navigating the resources or implementing any of the tools.

 

Other subjects discussed:

Q: How do you use an antibiogram to select antibiotics?
A: Generally speaking, in the absence of a culture and sensitivity report, you would try to use antibiotics that are at least 90% effective against the most common species for a particular type of infection.

Q: Can a nursing home use the antibiogram of a referring hospital?
A: As a starting point, the antibiogram of a referring hospital is better than nothing. That said, the better the lab results that make up the antibiogram reflect the actual lab results for the patients you serve, the better. One can check the lab results you receive against the hospital’s antibiogram and over time get a sense of how well the hospital’s antibiogram matches up with your actual lab results. Guidance for how to use and even construct an antibiogram is available on our Core Elements page, under “Actions to Improve Antibiotic Use”).

Q: How can nursing homes work with doctors who are not open to input on antibiotic stewardship?
A: Prescribers need to be told that the request to adhere to stewardship guidelines is rooted in

1.       facility policy and backed up by

2.       the medical director and organizational leadership and reflects

3.       published recommendations from professional and governmental authorities.

Prescribers may also respond to feedback on how their prescribing patterns compare to those of their peers as regards to adherence to facility policy. Sometimes, it is necessary for a prescriber to hear directly from a respected peer (such as a medical director, or consulting pharmacist) about the importance of antibiotic stewardship not only for patient safety, but also for organizational compliance with regulations.

Q: It’s all so overwhelming... what do you start on first?
A: Start with leadership commitment to forming an antibiotic stewardship committee that can develop and approve a stewardship plan and the policies and procedures to carry out the plan. The stewardship committee should include at a minimum the medical director, the consulting pharmacist, and the infection preventionist. The infection preventionist may expedite the process of developing a stewardship plan by selecting some of the ready-made policy templates (see above resources) to present to the full stewardship committee for adaption and approval.

Q: Does the antibiotic time-out policy apply to antibiotics started before transfer to the nursing home?
A: Yes…any new antibiotic, even those started before transfer to nursing home, should be evaluated at 48-72 hours to assess if treatment should be continued or changed.

Q: should we conduct an antibiotic time-out at 48-72 hours even if we have no culture and sensitivity results?
A: Yes, even if no new laboratory results (such as culture and sensitivity) are available, the clinical response to the antibiotic, measured against the indication for treatment and patient tolerance of treatment should still be evaluated at 48-72 hours after a newly started antibiotic. If C&S results come in later, they may still prompt yet another reassessment of treatment.

Q: Where can I find the sample letter to send to providers?
A: There are two sample letters from AHRQ. One is a called “Sample Letter to Prescriber” and the other is called "Sample Individualized Antibiotic Prescribing Profile Result."