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AMDA Long Term Care Medicine - 2012


B21 - Evidence-Based Antibiotic Prescribing in Long Term Care


Mar 9, 2012 1:30pm ‐ Mar 9, 2012 3:00pm

Description

Accreditation
The American Medical Directors Association (AMDA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation Statement:
The American Medical Directors Association designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AMDCP Credit Designation:
This session has been approved for a total of management 1.5 credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).

Session Description:
Antibiotic resistance is an increasingly important threat in long term care and has raised questions about whether prescribing rates can be safely reduced. This session will present data from current medical literature and two federally-funded trials of quality improvement programs aimed at reducing antibiotic prescribing, one in twelve nursing homes and the other in four assisted living communities. The session will discuss the causes and potential solutions to the problem of antibiotic resistance in long term care, situations where antibiotics are commonly prescribed but rarely needed and how to implement a program to monitor and safely reduce potentially inappropriate antibiotic prescribing in long term care settings.

Learning Objectives(s):

  • Describe the causes and potential solutions to the problem of antibiotic resistance in long term care.
  • Discuss 12 situations where antibiotics are commonly prescribed but rarely needed, including management alternatives when antibiotics are not prescribed.
  • Explain how to implement a program to monitor and safely reduce potentially inappropriate antibiotic prescribing in long term care settings.


Speakers(s):
Philip Sloane, MD, MPH; Sheryl Zimmerman, PhD

Disclosure(s):
Philip Sloane, MD, MPH has no financial disclosures to report. Sheryl Zimmerman, PhD has no financial disclosures to report.

References(s):
Bellmann-Weiler R, Weiss G. Pitfalls in the diagnosis and therapy of infections in elderly patient - a mini-review. Gerontology 55:241-249, 2009. Castle SC, Yeh M, Toledo S, et al. Lowering the temperature criterion improves detection of infections in nursing home residents. Aging Immunol Infect Dis. 1993;4:67-76. Daum RS. Clinical practice. Skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus. N Engl J Med. 2007; 357:380-90. Gardner SE, Frantz RA, Doebbeling BN. The validity of the clinical signs and symptoms used to identify localized chronic wound infection. Wound Repair and Regeneration. 2001; 9(3): 178-86. Gardner SE, Frantz RA, Troia C, Eastman S, MacDonald M, Buresh K, Healy D. A tool to assess clinical signs and symptoms of localized infection in chronic wounds: development and reliability. Ostomy Wound Management. 2001;47(1):40-47. High, K.P., Bradley, S.F., et al. (2009). "Clinical Practice Guideline for the Evaluation of Fever and Infection in Older Adult Residents of Long-Term Care Facilities: 2008 Update by the Infectious Diseases Society of America." Journal of the American Geriatrics Society 57 (3): 275-394. Juthani-Mehta M, Tinetti M, Perrelli E, Towle V, Van Ness PH, Quagliarello V. Diagnostic accuracy of criteria for urinary tract infection in a cohort of nursing home residents. Journal of the American Geriatrics Society. 2007; 55: 1072-7. Kaye KS, Stalam M, Shershen WE, Kaye D. Utility of pulse oximetry in diagnosing pneumonia in nursing home residents. The American Journal of the Medical Sciences. 2002; 324:237-42. Loeb M, Bentley DW, Bradley S, Crossley K, Garibaldi R, Gantz N, McGeer A, Muder RR, Mylotte J, Nicolle LE, Nurse B, Paton S, Simor AE, Smith P, Strausbaugh L. Development of minimum criteria for the initiation of antibiotics in residents of long-term-care facilities: Results of a consensus conference. Infection Control and Hospital Epidemiology. 2001; 22(2):120-4. Loeb MB, Carusone SB, Marrie TJ, Brazil K, Krueger P, Lohfeld L, Simor AE, Walter SD. Inter-observer Reliability of Radiologists' Interpretation of Mobile Chest Radiographs for Nursing Home-Acquired Pneumonia. Journal of the American Medical Directors Association. 2006; 7(7): 416-419. Liu C, Bayer A, Cosgrove SE, Daum RS, et al. Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant StaphylococcusAureus Infections in Adults and Children. Clinical Infectious Diseases 52:285-292, 2011. Magaziner J, Tenney JH, DeForge B, Hebel JR, Muncie HL Jr,Warren JW. Prevalence and characteristics of nursing home-acquired infections in the aged. Journal for the American Geriatric Society. 1991; 39:1071-8. Parmelee, P. A., B. Smith, et al. (1993). "Pain complaints and cognitive status among elderly institution residents." Journal Of The American Geriatrics Society 41(5): 517-522. Petersen I, Johnson AM, Islam A, Duckworth G, Livermore DM, Hayward AC. Protective effect of antibiotics against serious complications of common respiratory tract infections: retrospective cohort study with the UK General Practice Research Database. British Medical Journal. 2007;335:982. Sibbald RG, Woo K, Ayello EA. Increased bacterial burden and infection: The story of NERDS and STONES. Advances in Skin and Wound Care. 2006; 19(8):447-461. Strausbaugh LJ, Sukumar SR, Joseph CL. Infectious disease outbreaks in nursing homes: an unappreciated hazard for frail elderly persons. Clin Infect Dis. 2003; 36(7):870-6. Tingstr

Speaker(s):

  • Philip Sloane, MD, MPH, Distinguished Professor, Co-Director, Program on Aging, Sheps Center for HSR, University of North Carolina at Chapel Hill
  • Sheryl Zimmerman, PhD, Distinguished Professor, Co-Director, Program on Aging, Sheps Center for HSR, University of North Carolina at Chapel Hill

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