Name Organization AHRQ Pub No 1700065EF October 2016 Tool 5 Nursing Staff Training on Importance and Use of SBAR Forms Nursing Home Antimicrobial Stewardship Guide Determine Whether To Treat ID: 752769
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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
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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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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
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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).
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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.
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Resistant Strains Spread Rapidly
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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
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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
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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
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SBAR form Page 1
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SBAR form Page
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SBAR Form Page 1
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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
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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
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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
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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.
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