Antibiotic Stewardship - a losing battle for the DON

[Nascar nurse, ASN, RN]

Mr Y

To ER with complaints of upper abd pain and he insists he's going to ER. Returns with dx of UTI despite no urinary symptoms. Cipro for 10 days. Eventual culture report of E-coli (culture reports supports sensitivity to Cipro)

Cipro complete (still no urinary sx). Physician insists on reculture. Again comes back positive for E coli - and Dr restarts on Cipro. Because of lab problems and weekend delays, by the time we finally get sensitivity report the Cipro is nearly complete but now it's resistant to the Cipro anyways.

Nurses call Dr to report resistance to Cipro and also report resident is asymptomatic. Dr. takes 3 days to get back to us, but when he does he orders 10 days of Augmentin and another recheck following completion of ABT.

Not sure how I'm ever going to get antibiotic stewardship through to these old school Drs! Anyone with success stories?

[mander]

ADON here- We have issued out the McGeer criteria a billion times. We rely heavily on our nurses to not run to the MD about every little burning with urination. We make them document vital signs, all possible s/s UTI and if they are NOT present, and tell them to push fluids. We don't let them do in house UAs anymore. Families are not to dictate us to get urine samples because their mom's urine "smells funny" or "looks funny". We have long talks with the doctor.

...It worked for a while, but we have to keep at it. We have one PA that gets mad and is rude to us (us jerks in the lab coats are "the man" and he's against "the man). Our medical director seems to get it sometimes, but other times he caves when families approach him. We have an Optum NP that seems to not care. It's rough! But I think not having your staff report every little possible maybe almost sign of a UTI helps. It's difficult to get the nurses to steer away from this thought though. Even in nursing school we were taught about UTIs and how common they were and oh, must be the cause of an elderly person's problems when it's most likely respiratory or some other condition.

Then there's the fabulous "UTI and dehydration" dx from hospitals.