Electronic flashcards presenting NVBAP best practices and common clinical scenarios https aspnmorgnonvisitbasedantibioticshtml Table of Contents Best practice Patient reported symptoms ID: 927893
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Slide1
Non-Visit-Based Antibiotic Prescribing (NVBAP)
Electronic flashcards presenting NVBAP best practices and common clinical scenarios
https://
asp.nm.org/nonvisitbasedantibiotics.html
Slide2Table of Contents
Best practice: Patient reported symptoms
…………………………………………...............…
1Q
Antibiotic appropriateness: Respiratory symptoms
………………………...……..……………
2Q
Recommended script: Schedule office
visit
……………………………………………………….3Q
Best practice: Scheduling conflicts
………………..………………………………………..………..
4Q
Best practice: Domestic
travel
…………………………………..…………………..………………….
5Q
Recommended script: Domestic travel
…………………………………..………………………….
5Q
Best
practice: Infection exposure
………………………………………………………..……….……6Q
Antibiotic resistance
education
……………………………………………………………...………....
7Q
Recommended script: Antibiotic resistance
education
………………..……………...…..…
8Q
Recommended script: Antibiotic resistance for infrequent users
…………………..…….
9Q
Recommended script: UTI symptoms
…………………………………………………………..…..10Q
Recommended script: Skin/soft
tissue symptoms…………………………………….……..11Q
Additional resources
......................................................................................................12
Slide3Your patient calls:
“I have had a cough and runny nose the last 3 days. Can I get something for this?”
How do you respond?
1Q
Patient reporting symptoms
Slide4Don’t assume your patient is requesting antibiotics if s/he does not explicitly mention antibiotics
Encourage symptom-focused treatment (including natural remedies such as humidifier and decaffeinated tea with honey)
Equip patient with
NVBAP Symptom Management Handout
Patient reporting symptoms
1A
Slide5Would you prescribe an antibiotic without an office visit given the scenario below?
Your patient:
“I’ve had a cough for the last 3 days. I have a big presentation in 2 days and need this cough to go away now! Can you prescribe something? Too busy preparing for presentation to go into office
.”
2
Q
Antibiotic appropriateness: Respiratory Symptoms
Slide6An antibiotic prescription is
not appropriate
in this case.
Best
practice is to recommend
analgesics or decongestants. Or combination medicines with analgesics and/or
decongestants.Remind your patient that a cough for up to 21 days
is completely
normal and is likely to relieve with
time. Antibiotics
do not shorten the duration of cough, do not prevent complications, and have common side effects like diarrhea and rashes
.Patients should be feeling better over the 21 days, but they should be feeling gradually better.Advise your patient that if after 21 days the cough is not better, or they start feeling worse at any time, then it is time for an office visit. Examples of “red flags” are high fever, confusion, difficulty breathing, difficulty swallowing, severe headache, pain in your face or forehead, severe fatigue, or rash.71% of non-visit-based antibiotics are related to patient reported symptoms
2A
Antibiotic appropriateness: Respiratory Symptoms
Slide7How should you respond to a patient requesting an antibiotic whose symptoms need evaluation in an office visit?
Script: Scheduling office visit
3
Q
Slide8Recommend script:
“I hear your concerns.
Your symptoms do not sound like fun.
I need to see you to personalize your treatment.
Can we schedule an office visit?”
Script: Scheduling office visit
3
A
Slide9What do you do if your patient has symptoms that need an evaluation in an office visit, but there are scheduling conflicts?
Scheduling conflicts
4
Q
Slide10If it’s difficult to fit the patient into your schedule or a colleague’s schedule, refer patient to a convenience clinic, such as urgent care or a retail clinic (e.g., CVS
MinuteClinic
).
Scheduling conflicts
4
A
Slide11How would you address an antibiotic request ahead of domestic travel?
5
Q
Request for domestic travel kit
Slide12Delay decision to prescribe. Remind your patient that…
y
our clinic only prescribes antibiotics when they will do more good than harm
antibiotics may be able to be phoned in later
Recommend script:
“I understand you’d prefer a prescription right now to have on hand. However, antibiotics often cause more harm than help. If symptoms present themselves while you are away, you can call us. If it will be a help, we will be happy to send a prescription to your closest pharmacy then.”
Equip patient with
NVBAP Travel Handout
5
A
Request for domestic travel kit
Slide136
Q
Infection exposure scenario
Would you prescribe an antibiotic without an office visit given the scenario below?
Your patient:
“
There’s been a case of whooping cough at the daycare I work at. Is there something I should take?
”
Slide146
A
Pertussis
postexposure
prophylaxis
is
recommended within 21 days of the onset of cough in an index patient if the person is around:
infants under 12 months of age,
women in their third trimester of pregnancy,
people
who are immunocompromised, have moderate-to-severe asthma, or other pre-existing health condition that may be exacerbated by pertussis.
Infection exposure scenario
Slide15What are some reasons antibiotics are not the best treatment option?
7
Q
Antibiotic resistance education
Slide16Antibiotics
don’t help viral symptoms
Side effects:
indigestion, nausea, skin rash, diarrhea
Microbiome disruption:
antibiotics kill off lots of good bacteria in our bodies
Antibiotic resistance: bacteria becomes less responsive to antibiotics, making future infections untreatable
7
A
Antibiotic resistance education
Slide17How would you educate your patient on antibiotic resistance?
8
Q
Script: Antibiotic resistance education
Slide18Ineffective for viral symptoms:
“Antibiotics won’t help your symptoms go away faster.”
Side effects:
“Antibiotics could cause more harm, like diarrhea.”
Antibiotic resistance:
“Bacterial infections will eventually become untreatable with antibiotics. We are trying to delay that problem by not prescribing unnecessary antibiotics.”
Balancing risks and benefits: “An antibiotic is more likely to hurt you than to help you
.”
Equip patient with
Antibiotic Resistance Education Handout
Script:
Antibiotic resistance education8A
Slide19How would you educate your patient on antibiotic resistance who rarely uses antibiotics so the patient believes their antibiotic use is not contributing to resistance?
9
Q
Script: Antibiotic resistance education for infrequent users
Slide209
A
Script:
Antibiotic resistance education for infrequent users
Recommend script:
“I understand you rarely use antibiotics. However, all antibiotic use contributes to bacteria becoming resistant, regardless of who is using antibiotics.”
Slide2110Q
Script: UTI symptoms
How would you respond to a patient reporting urinary frequency and burning?
Slide22Script:
UTI symptoms
For patients
with a history of UTIs
, it may be reasonable to prescribe without office visit. Do use your best judgement.
For patients
without a history of UTIs
, an office visit and/or labs are recommended.
Recommend script:
“I understand you are experiencing discomfort and would like an immediate resolution. To provide the best treatment, we first need a urinalysis/urine culture.”
10A
Slide23Script: Skin/soft tissue symptoms
Patient has left ankle swelling that is warm to the touch. Pain earlier, but now denies pain to ankle. How would you respond?
11Q
Slide24Script:
Skin/soft tissue symptoms
For patients
with known health history
, it may be reasonable to prescribe without office visit. Do use your best judgement
.
For patients
without a history of skin condition
, an office visit for proper evaluation recommended.
Recommend script:
“It’s difficult for me to diagnose this over the phone/online. I don’t want to misdiagnose you and possibly delay effective treatment for your condition. Can we schedule an office visit?”
11A
Slide25Additional resources
NVBAP Teaching Tool
NVBAP Evidence Summary
Antibiotic Use Resource ListPatient handouts
NVBAP
Symptom Management Handout NVBAP Travel HandoutAntibiotic Resistance Education12