Too many ABTs?!

[jojo489]

Hello all.

I work in an assisted living facility right now....most of my residents are 75 and above. I've noticed that with absolutely any little change in status, we are getting urines, which I know is popular in nursing homes all over, but what really gets me is the amount of antibiotics that are prescribed.

I mean, for everything. Wounds that look like they might be infected (without even getting a culture), UTIs, and just today, for pharyngitis. We always have someone on an antibiotic.

I feel like a lot of these residents are getting these ABTs so often that they're going to become resistant.

Has anyone else seen this in practice? What are your feelings on this?

[kiszi, RN]

Agree. Thankfully the NH I work in now doesn't seem to over prescribe abts, but I have seen the practice far too often in the past. Cough x 3 days, CXR clear? ? Z-pac! Pt is asymptomatic but urine culture shows slight bacterial growth? Toss some Macrobid at em!

I believe in some cases antibiotics are used as a CYA and keep-em-happy measure. I prefer the approach where pts and families are actually educated on proper abt use and given rationales why abt in some cases may not be in the pt's best interest.

[jojo489]

Amen.

[Nica-RN, RN]

The place I work is the same, some cough, call the doctor and give an antibiotic. Up to 1/3 of my residents are currently under ABT. I have the same fear of developing a resistant with this much amount given, unfortunately in my facility is the trend to given even more and more.

[casi, ASN, RN]

I am so thankful that my current place of employment really pushes the idea of chronic urinary tract colonization and only treating symptomatic positive UA/UCs. Also not collecting UA/UCs just because Mrs. Jones fell, is more confused, or looked at a staff member funny. It's really a matter of educating staff and educating prescribers.

I also think that we are working with a population that believes there is/wants a pill or a cure for everything. I can't tell you how many patients I've had who demand cough syrup or Imodium after I explain that their cough or their small amount of diarrhea is beneficial in what their body is fighting off. I think that healthcare workers as a whole get sick of arguing are afraid of bad customer service surveys so they become complacent and give patients what they want.

AMDA: Publications - Caring for the Ages - October 2002