What is it, Why is it Important and What is Your Role? Aug 16, 2017

Transcription

1 What is it, Why is it Important and What is Your Role? Aug 16, 2017 Paul Bonnar (MD, FRCPC) & Andrea Kent PharmD

2 What is Antimicrobial Stewardship? Coordinated interventions designed to improve and measure the appropriate use of antibiotics Right drug Right dose Right duration Barlam. CID. 2016;62(10):e51 e77 Tamma CID 2017;64(5): Right route

3 WHY IS AMS IMPORTANT?

4 What Does a Post Antibiotic Era mean?

5 It means we are heading back to a time where common illnesses like pneumonia and minor surgical procedures will once again be feared killers because we do not have antibiotics to combat them due to developing resistance. Fluoroquinolones which were introduced in 1980 with zero resistance now have as much as 50% resistance to E. coli in some countries MRSA counts for almost 90% of Staph infections in parts of the USA People with MRSA infections have a 64% increase risk of death

6 Why is AMS Important? O Neill Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations

7 Why is AMS Important? Increasing MDR organisms Side-effects / costs of antimicrobials Accreditation Canada ROP O Neill. Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations

8 Tamma. JAMA Intern Med Jun 12

9 VISION Safe and effective use of antimicrobial agents in patients cared for in the NSHA

10 TENETS Promote a culture of optimal antibiotic use Respect and promote regional strengths Act in collaborative and engaging manner Make evidence-based recommendations Maintain an open/transparent program Start small, build on success

11 Team members Andrea Kent Paul Bonnar Ian Davis Kim Abbass Jason Reynolds Stephen Smith Valerie Murphy

12 WHAT IS NURSING S ROLE?

13 CID 2016;62(1):84 9

14 CID 2016;62(1):84 9

15 Situation 30 40% of patients will receive an antibiotic while in hospital Growing number of resistant bacteria Most nursing staff will come face to face with the consequences of our antimicrobial resistance crisis

16 Survey of nursing staff in Australia 65% knew or had heard of the term Antimicrobial Stewardship or AMS 57% rated their knowledge of antimicrobials as minimal or limited Hand hygiene, infection control, and knowledge of antimicrobials were most commonly seen as nursing role Prompting switch from IV to oral, therapeutic drug monitoring and checking restriction status were less frequently thought of as nursing roles Infection, Disease & Health (2017) 22, 57e64

17 Why has nursing not been a focus? Prescribing emphasized over MANAGING antibiotics Hierarchy & Tradition Time constraints Knowledge

18 What is Nursing s Role in AMS? AMS is multidisciplinary Nurses are the operational and communication hub Trusted by patients and families Many existing roles of nursing already fit well with AMS roles

19 Nursing benefits Better patient outcomes Less resistance: less isolation Less C. difficile Less abx administration

20 CID 2016;62(1):84 9

21 CID 2016;62(1):84 9

22 Triage - Early recognition of sepsis Early cultures and Abx Clarification of allergies Daily nursing care - Monitor abx (duration, dose, IV) -Early C diff / sepsis - Correct culturing - Culture reports -Educating families - Prevention (catheter removal) Discharge - Duration -OPAT - Follow-ups

23 Allergies Penicillin most commonly reported allergy 95% are not truly allergic reactions Minor adverse reactions or intolerances (eg nausea or diarrhea) Non severe delayed type hypersensitivity reactions (eg. maculopapular rashes)

24 Allergies Over reporting of allergies is NOT benign Alternative antibiotics may be less effective or have more adverse effects Increased selection of resistant bacteria More often on more than one antibiotic Increased risk of ICU admission Longer lengths of stay Increased risk of death

25 What can Nursing Do? Ask what the reaction was If on old charts question further

26 Catheters and CAUTI In one centre a nurse directed catheter removal protocol reduced catheter use by 50% and CAUTI by 70%. ICU nurse reminders to physicians for catheter removal reduced both CAUTI and costs

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29 Managing the Patient with a possible UTI: Facts!! Malodorous /cloudy urine alone is NOT a sign /symptom of a UTI Changes in cognitive function or ADL s require a clinical assessment first before assuming this is due to a UTI Urine should always be collected as a midstream or in/out catheterization

30 Managing the Patient with a possible UTI: Facts!! Positive urine cultures in asymptomatic patients should NOT be automatically treated (except in pregnancy or prior to urological/gynecological procedures UTI is a clinical diagnosis not a lab diagnosis!! Delirium is not considered a typical symptom of a UTI for non-catheterized patients.

31 Questions?