Antibiotics and gray area

[HillieRN]

I would love to hear some commentary from experienced RN's RE antibiotics. There seems to be a lot of gray area where I work. Do some agencies have protocols or algorithms for this they can share?

[NC29mom, ASN, LPN, RN]

As far as what? If ABT are appropriate, or which ABT are used for this or that?

We treat with abt...regularly. (PO) I think in the past a lot of hospice organizations didnt use. . But that changed with time. I remember when hospice would come in a SNF & write "D/C all meds, labs, no ER visits or hospitalizations" not anymore...

As far as the antibiotics used, we try to use formulary abts first, so no expense to pt

** part of the non-disease & disease specific LCD criteria includes that pt had previously been treated with abt unsuccessfully.

[HillieRN]

Thanks NC for the reply. :) I have difficulty discerning if an antibiotic is appropriate or not, in some situations.

One example could be an Alzheimer's pt who is unable to communicate and has a lady partsl discharge. She does not appear to have pain/distress, nor does she have a fever or mental status changes. The family is requesting an antibiotic or treatment.

[ktwlpn, LPN]

I would think an antifungal insert would be appropriate as a comfort measure. She may not be able to convey discomfort due to her dementia .If she has been on an antibiotic recently she probably does have a problem and if you have even had one you know it's not a fun thing.

[TammyG]

We frequently dispense antibiotics for everything from UTIs to ear infections to pneumonia. To withhold them would place the patient in continued discomfort and risk an earlier death. Of course, sometimes the family does not want to treat, and that is fine.