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Toolkit 3. Minimum Criteria for Common Infections Toolkit

[Name]. [Organization]. AHRQ Pub. No. 17-0006-5-EF. October . 2016. Tool 5. Nursing Staff Training on Importance and Use of SBAR Forms. Nursing Home Antimicrobial Stewardship Guide. Determine Whether To Treat.

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Toolkit 3. Minimum Criteria for Common Infections Toolkit






Presentation on theme: "Toolkit 3. Minimum Criteria for Common Infections Toolkit"— Presentation transcript:

Slide1

Toolkit 3. Minimum Criteria for Common Infections Toolkit

[Name][Organization]

AHRQ Pub. No. 17-0006-5-EFOctober 2016

Tool 5. Nursing Staff Training on Importance and Use of SBAR Forms

Nursing Home Antimicrobial Stewardship Guide

Determine Whether To TreatSlide2

Agenda

Background and PurposeSuspected Infection SBAR Forms

Using the Suspected Infection SBAR Forms

Next Steps

Nursing Home Antimicrobial Stewardship GuideDetermine Whether To Treat

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2Slide3

Objectives

Identify problems with unnecessary antibiotic

useLearn how to provide critical information to prescribing clinicians to make an informed decision

Understand the minimum criteria for antibiotics for the three most common infections:Urinary tract

Skin and soft tissueLower respiratory

Nursing Home Antimicrobial Stewardship Guide

Determine Whether To Treat

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Background: Antibiotic

Use in Nursing Homes

Between 50% and 70% of nursing home residents will receive at least one course

of systemic antimicrobial agent during a

calendar year.

20–30% of residents may receive

multiple

courses during a calendar year.

Frequent use of antibiotics has produced

a

variety of multidrug-resistant bacteria

(e.g., MRSA and VRE).

Nursing Home Antimicrobial Stewardship Guide

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Problems With Antibiotics

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GI = gastrointestinal

HAI = healthcare-associated infectionSlide6

Antibiotic Use in Nursing Homes Creates Risks for Multiple Groups

The most recent trend in healthcare-associated infections is the growing incidence in the community of drug-resistant microbes. They are a threat to more than the residents in the nursing home themselves.

Bacteria can migrate to caregivers in the nursing home, who then unknowingly share them with family and the community.

Nursing Home Antimicrobial Stewardship GuideDetermine Whether To Treat

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Resistant Strains Spread Rapidly

Nursing Home Antimicrobial Stewardship GuideDetermine Whether To Treat

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Percent of Isolates

Source: 

Infectious

Diseases Society of

America. Bad Bugs, No Drugs: As Antibiotic Discovery Stagnates…A Public Health Crisis Brews. July 2004.

http://

www.idsociety.org/uploadedFiles/IDSA/Policy_and_Advocacy/

Current_Topics_and_Issues

/

Antimicrobial_Resistance

/10x20/

Images/Bad%20Bugs%20no%20Drugs.pdf#search

=%22spread%20of%20mrsa%20vre%22Slide8

Few New Antibiotics

Nursing Home Antimicrobial Stewardship GuideDetermine Whether To Treat

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Source: 

Boucher HW, Talbot GH, Benjamin DK Jr., et al. 10 × '20 Progress—Development of new drugs active against gram-negative bacilli: an update from the Infectious Diseases Society of America.

Clin

Infect Dis. 2013 Jun;56(12):1685-94.

FDA = Food and Drug AdministrationSlide9

Antibiotic Use in Nursing Homes

for Suspected UTIsIn a recent study, more than half of the prescriptions of antibiotics for a suspected UTI were for residents who were asymptomatic.No evidence indicates that antibiotics help with asymptomatic bacteriuria.

There is evidence that they can do harm.Nursing Home Antimicrobial Stewardship Guide

Determine Whether To Treat

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Overview

Suspected UTI/SSTI/LRTI SBAR forms: Are intended to guide communication regarding the potential need for antibiotic use between nursing staff and prescribing clinicians in long-term care facilities, such as nursing homes.

Are based on the s

ituation, background,

assessment, and r

equest form of communication, or SBAR.

Are based on clinical practice guidelines.

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Guidelines for Antibiotic Use

The guidelines are based on evidence.

Researchers developed guidelines for a few key infections that are common in nursing homes.

Other researchers independently used these guidelines, tested them, and found that they were effective in reducing the number of antibiotics used.

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SBAR Tool Design

S – Situation: A concise statement of the problem (what is going on now).

B – Background: Pertinent and brief information related to the situation (what has happened).A – Assessment: Analysis and consideration of options (what you found/think is going on).

R – Request: Ask for/recommend action (what

you want done). Nursing Home Antimicrobial Stewardship Guide

Determine Whether To Treat

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SBAR form Page 1

Nursing Home Antimicrobial Stewardship GuideDetermine Whether To Treat

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SBAR form Page

2Nursing Home Antimicrobial Stewardship GuideDetermine Whether To Treat

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SBAR Form Page 1

Nursing Home Antimicrobial Stewardship GuideDetermine Whether To Treat

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UTI SBAR

Form Page 1Nursing Home Antimicrobial Stewardship GuideDetermine Whether To Treat

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UTI SBAR

Form Page 1Nursing Home Antimicrobial Stewardship GuideDetermine Whether To Treat

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UTI SBAR

Form Page 1Nursing Home Antimicrobial Stewardship GuideDetermine Whether To Treat

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UTI SBAR Form Page 2

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UTI SBAR

Form Page 2

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UTI SBAR

Form Page 2

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UTI SBAR

Form Page 2

Nursing Home Antimicrobial Stewardship GuideDetermine Whether To Treat

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UTI SBAR

Form Page 2

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All SBAR Forms Page 2

(continued)

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Review

Form groups

Think about recent resident who had a UTI; did that person’s symptoms meet the criteria?Have you ever seen a situation where a resident did not meet the criteria? What happened?

Report back

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Suspected Skin and

Soft Tissue Infection SBARNursing Home Antimicrobial Stewardship GuideDetermine Whether To Treat

Toolkit 3/Tool 5 26Slide27

Suspected SSTI Infection SBAR

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Suspected SSTI SBAR Page 2

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Suspected SSTI SBAR Page 2

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Suspected SSTI SBAR Page 2

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Suspected Lower Respiratory

Tract Infection SBARNursing Home Antimicrobial Stewardship GuideDetermine Whether To Treat

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Suspected LRTI SBAR

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Suspected LRTI SBAR Page 2

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Suspected LRTI SBAR Page 2

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Questions and Review

Thoughts? Any surprises?

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Summary

The Suspected Infection SBAR forms are now the home’s protocol to communicate with prescribing clinicians.They are used in all instances in which nursing staff communicate to seek treatment guidance from clinicians

about suspected UTIs, SSTIs, and LRTIs.If a prescribing clinician is on site, then a Suspected Infection SBAR form should still be completed for the prescribing clinician’s review.

The information on the Suspected Infection SBAR form should be provided to the prescribing clinician before the decision to initiate treatment with antibiotics.

Nursing Home Antimicrobial Stewardship GuideDetermine Whether To Treat

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