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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/ambulatory-care/antibiotic-prescribing-guide.docx
September 01, 2022 - antibiotic prescribing practices in the ambulatory care setting
Slide 2
The Importance of Antibiotics … SAY:
The discovery of antibiotics has led to countless lives being saved compared to the pre-antibiotic … Slide 4
Antibiotic Overuse
SAY:
At least 30 percent of all antibiotics prescribed in ambulatory practices … It is susceptible to all tested antibiotics. … Program for Improving Antibiotic Use – Ambulatory Care Antibiotics & Clostridioides difficile 12
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/improve/program-part2-facilitator-guide.pdf
November 01, 2019 - of antibiotics optimized. … An antibiotic time out allows providers
or teams to review their patients on antibiotics to
determine … if the antibiotics are needed or if they could
be modified at a designated time each day. … ASPs
should direct them to focus on specific antibiotics that
for which use can be decreased. … An
example might be, “Helping patients receive the right
antibiotics when they need them.”
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www.ahrq.gov/topics/antimicrobial-stewardship.html
use by getting residents the right antibiotics when they need them. … Toolkit To Determine Whether It Is Necessary To Treat a Potential Infection With Antibiotics : This toolkit … toolkit helps residents and their family members understand what the nursing home is doing to make sure antibiotics … are used properly, what the risks of taking antibiotics are, and what they can do to be engaged in decisions … Telemedicine-Based Antimicrobial Stewardship Program Improves Prescribing, Reduces Bacterial Resistance to Antibiotics
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/resources/tools/reduce/when-need-antibiotic.pdf
March 01, 2017 - When Do You Need An Antibiotic?
When Do You
Need An
Antibiotic? … What is “antibiotic resistance”? … to the antibiotic. … That’s why it’s
best to use an antibiotic only when it’s absolutely necessary. … Don’t take an antibiotic for a virus (cold or flu).
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/improve/program-part1-facilitator-guide.pdf
November 01, 2019 - in infectious diseases or
not, the physician lead should have an interest in both
optimal use of antibiotics … and restriction decisions regarding antibiotics and thus
should have ample ASP representation. … Since the primary target of guidelines is
clinicians who prescribe antibiotics, we recommend
selecting … are
to encourage clinicians to think about what the right
antibiotics are for the syndrome they suspect … It is, however, reasonable to consider guidelines for use
of select antibiotics that are expensive or
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/ambulatory-care/antibiotic-prescribing-slides.pptx
September 01, 2022 - Antibiotic Use – Ambulatory Care
2
The Importance of Antibiotics
Saved countless lives
Prompt administration … 30% of antibiotics prescribed in ambulatory practices are unnecessary9
59% of antibiotic expenditures … Lingering cough; antibiotics extended for a 14-day course
6
Focus on Antibiotic Prescribing
AHRQ … Care
10
Antibiotics & Clostridioides difficile12
Virtually all antibiotics can
increase the risk … antibiotics also have associated harm
Promoting antibiotic stewardship can improve patient outcomes
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/improve/gap_analysis_tool.docx
November 01, 2019 - ☐ Yes
☐ No
☐ N/A
➕Do your facility guidelines provide recommendations about specific antibiotics? … Consider
➕Is there is a formal procedure for all clinicians to review the appropriateness of all antibiotics … there a process for intravenous to oral conversion of antibiotics in the pharmacy? … ☐ Yes
☐ No
➕Are activities conducted by the ASP to target antibiotics commonly associated with C. … any culture or susceptibility results as a strategy to assist prescribers in selecting appropriate antibiotics
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/overall-antibiotic-stewardship-project-final-report.pdf
September 01, 2022 - However, misuse of antibiotics has led to avoidable harm such as emergence of antibiotic
resistance … /index.html
2
who receive antibiotics in the hospital will develop an antibiotic-associated adverse … Antibiotic use was stratified by individual antibiotics. … Antibiotic use was
stratified by individual antibiotics. … Rethinking how antibiotics are prescribed: incorporating the 4
Moments of Antibiotic Decision Making
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www.ahrq.gov/sites/default/files/wysiwyg/nhguide/4_TK2_T2-Antibiotic_Pocket_Cards.pdf
May 01, 2014 - • Especially consider in residents who received antibiotics
in previous 60 days and have one or more … • Use anti-MRSA antibiotic empirically for abscess or
chronic ulcer meeting criteria for deep infection … www.ahrq.gov
Agency for Healthcare Research and Quality
12 Common Nursing Home Situations
in Which Systemic Antibiotics
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/ambulatory-care/sustaining-antibiotic-slides.pptx
September 01, 2022 - Sustaining Antibiotic Stewardship Efforts – Slides
AHRQ Safety Program for Improving Antibiotic Use … Sustaining Antibiotic Stewardship Efforts
AHRQ Safety Program for Improving Antibiotic Use
Ambulatory … Step four: Determine how to access antibiotic prescription data. … Step seven: Monitor and report back antibiotic prescription data to practice. … After this period, ongoing antibiotic stewardship efforts are needed to continue to observe optimal antibiotic
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/four-moments-explained.pdf
June 01, 2021 - The prescriber should choose an antibiotic
that covers the most likely pathogens. … What duration of antibiotic therapy is needed for the resident’s
diagnosis? … It’s been 2–3 days since we started antibiotics. … Can we stop antibiotics? Can we
narrow therapy? Can we change to oral antibiotics? … If the resident is getting an intravenous antibiotic, can they
get an oral antibiotic instead?
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/four-moments-form.pdf
June 01, 2021 - Four Moments of Antibiotic Decision Making Form
AHRQ Safety Program for
Improving Antibiotic … Antibiotic regimen and indication:
Antibiotic: ___________________________________________________ … Were appropriate cultures ordered before antibiotics were started? … CAN WE STOP ANTIBIOTICS? CAN WE NARROW THERAPY?
11. Are antibiotics still needed? … CAN WE STOP ANTIBIOTICS? CAN WE NARROW THERAPY?
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/ambulatory-care/bronchitis-slides.pptx
September 01, 2022 - that requires antibiotics? … -3
6
Acute Bronchitis
AHRQ Safety Program for Improving Antibiotic Use – Ambulatory Care
6
Antibiotics … Moments of Antibiotic Decision Making
Does my patient have an infection that requires antibiotics? … that requires antibiotics? … Antibiotics for Acute Bronchitis
11
Year
Percentage of Bronchitis Visits With Antibiotic Prescriptions
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/poster-4x6-four-moments-single.pdf
June 01, 2021 - Four Moments of Antibiotic Decision Making Poster
AHRQ Pub. … Have we
collected appropriate cultures before
starting antibiotics? … What duration of antibiotic therapy is
needed for the resident’s diagnosis? … It has been 2–3 days since we started
antibiotics. … Can we
stop antibiotics? Can we narrow therapy?
Can we change to oral antibiotics?
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/long-term-care/four-moments-poster.pdf
June 01, 2021 - Four Moments of Antibiotic Decision Making Poster
Does the resident have symptoms that suggest an infection … Have we collected appropriate cultures
before starting antibiotics? … 1
What duration of antibiotic therapy is needed for the resident’s diagnosis? … It’s been 2–3 days since we started antibiotics. … Can we stop antibiotics? Can we
narrow therapy? Can we change to oral antibiotics?
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www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/implementation/education-bundles/urine-culturing/antibiotic-stewardship/part-2-slides.html
February 01, 2019 - Slide 7: Antibiotic Use in LTC Facilities 6-9
Antibiotics are frequently used in long-term care … Antibiotics can cause harm to residents
High risk of side effects and adverse events. … Bacteria are constantly evolving, requiring the need for new antibiotics. … Antibiotics for Urinary Tract Infections in Older People (AGS) . 2013 Consumer Reports. … Antibiotics for Urinary Tract Infections in Older People (AGS) . 2013 Consumer Reports.
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/ambulatory-care/pharyngitis-slides.pptx
September 01, 2022 - The “Sometimes Antibiotics” Diagnoses: Pharyngitis – Slides
AHRQ Safety Program for Improving Antibiotic … that requires antibiotics? … Four Moments of Antibiotic Decision Making
4
Does my patient have an infection that requires antibiotics … that requires antibiotics? … that requires antibiotics?
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/ambulatory-care/sinusitis-slides.pptx
September 01, 2022 - The “Sometimes Antibiotics” Diagnoses: Sinusitis – Slides
AHRQ Safety Program for Improving Antibiotic … Antibiotic Decision Making
Does my patient have an infection that requires antibiotics? … of Antibiotic Decision Making
Does my patient have an infection that requires antibiotics? … that requires antibiotics? … that requires antibiotics?
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www.ahrq.gov/sites/default/files/wysiwyg/antibiotic-use/safety/changes-facilitator-guide.pdf
November 01, 2019 - Does my patient have an infection that requires
antibiotics?
2. … Have I ordered appropriate cultures before starting
antibiotics? … Can I stop antibiotics?
Can I narrow therapy or change from IV to oral
therapy?
4. … Making
Continued
SAY:
The patient remained on intravenous antibiotics for the
duration of his … Negative team factors include no mechanism for daily
review of antibiotics; poor written or verbal
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www.ahrq.gov/funding/grantee-profiles/grtprofile-trautner.html
October 01, 2023 - Grantee Profile
Reducing Harms from Unsafe Use of Antibiotics and Preventing the Spread of Antibiotic … Unsafe antibiotic use includes obtaining and using prescription antibiotics without a prescription, using … another person's antibiotics, or using one's own stored antibiotics for a reason other than originally … Taking prescription antibiotics without a prescription increases the risk of antibiotic resistance, adverse … and penicillin, at home, with younger caregivers more likely to store and use these antibiotics.