miércoles, 3 de junio de 2015

Antibiotic Stewardship: Using Evidence-Based Safe Prescribing Practices | Safe Healthcare | Blogs | CDC

Antibiotic Stewardship: Using Evidence-Based Safe Prescribing Practices | Safe Healthcare | Blogs | CDC

CDC. Centers for Disease Control and Prevention. CDC 24/7: Saving Lives. Protecting People.

Antibiotic Stewardship: Using Evidence-Based Safe Prescribing Practices

Posted on  by CDC's Safe Healthcare Blog

Jason G. Newland, MD, MEd, FPIDS

Jason G. Newland, MD MEd FPIDS

Guest Author – Jason G. Newland, MD MEd FPIDS
Medical Director of Patient Safety and Systems Reliability
Children’s Mercy Hospitals & Clinics, Kansas City, Missouri
Antibiotic resistance is one of the nation’s most pressing public health threats. Yesterday CDC led several important discussions at the White House Forum on Antibiotic Stewardship. This forum is a key step in implementing the White House’s new National Action Plan for Combating Antibiotic-Resistant Bacteria, which was issued in March.
While antibiotic-resistant infections outside of the hospital setting used to be rare, that has changed—we now see resistant bacterial infections in young, healthy people in the community. Furthermore, side effects from antibiotics commonly lead to additional healthcare visits. More than 262 million courses of antibiotics are prescribed in the community each year, enough for five out of every six people. We know that prescribing antibiotics when not needed or prescribing the wrong antibiotic is common. For example, antibiotics are given for strep throat without utilizing the confirmatory laboratory test, which is essential in assuring antibiotics are used appropriately. In other cases, patients and caregivers expect antibiotics for treatment of conditions such as a cold when antibiotics are not needed. Such practices contribute to the growing problem of antibiotic resistance and lead to many unnecessary medical visits due to antibiotic-associated side effects. A common side effect of antibiotics that often gets overlooked is C. difficile infections, a diarrheal illness that contributes to a quarter of a million infections and approximately 15,000 deaths annually in the United States.
We all strive to provide high quality medical care for our patients and families, which includes only prescribing antibiotics for bacterial infections. While prescribing antibiotics when needed might seem easy, we understand that time constraints, diagnostic uncertainty, and concerns over patient satisfaction make it very difficult. Thankfully, strategies are available to support us in excelling in outpatient antibiotic stewardship. CDC’s Get Smart: Know When Antibiotics Work program recommends proven evidence-based methods to optimize antibiotic therapy for individuals while minimizing harms to both the patient (e.g., side effects, C. difficile infection) and the community (e.g., bacterial resistance). These include:
  • Quality improvement systems that compare individual clinician prescribing rates, peers’ rates or expected rates based on clinical practice guidelines.
  • Academic detailing to improve clinical decision making, including the appropriate use of antibiotics.
  • Clinical decision support (CDS) strategies that use signs and symptoms to facilitate accurate diagnoses and treatment.
  • Delayed prescribing practices, which encourage patients to wait and see 24‒48 hours after a clinical visit determine if an antibiotic is needed.
  • Displaying posters within clinical settings to educate patients and clinicians, reducing patient expectations for antibiotics, and advertising clinician commitment to judicious antibiotic prescribing.
I encourage you to read the National Action Plan and learn more about Get Smart: Know When Antibiotics Work. You will also find a wealth of materials on that website to facilitate the conversation with your patients when antibiotics aren’t indicated. We owe it to our patients and communities to take action now. Prior to the development of antibiotics, children and adults often died of common outpatient infections like pneumonia and skin infections. We are at a crossroads where treating common infections may become impossible to cure with antibiotics like it was just over 80 years ago.
Posted on  by CDC's Safe Healthcare Blog

No hay comentarios:

Publicar un comentario