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May 7, 2018
2018 Science Writers’ Boot Camp
National Harbor 1
Old Habits Die Hard:
Reining in Antibiotic Use in
Older Adults
Morgan Katz, MD MHS
Assistant Professor of Infectious Disease
May 11, 2018 2
Antibiotics are vastly over-prescribed
to older adults
May 11, 2018 3
Nausea/Vomiting
Kidney injury
Clostridium
Difficile InfectionLiver injury
Rash
Antibiotic Exposure Leads to
Resistance and Alters the Microbiome
May 11, 2018 4
We are Rapidly Losing Antibiotic
Options
May 11, 2018 5
What is Antibiotic Stewardship?
Appropriate use of antibiotics
• Right drug
• Right dose
• Right indication
• Right duration
http://www.darkcloudblogs.com/2017/09/inside-character-sheet-steward.html
https://twitter.com/ABsteward
Oxford Biosystems
Technical problems and solutions
• Computer shuts down Call tech support
• Water leaking in a house Call a plumber
**Assign the problem to an expert, and get out of
the expert’s way**
Inappropriate antibiotic prescribing NOT AN
EASY FIX
Inappropriate Antibiotic
Prescribing
Vague
clinical
symptoms
Unclear
guidelines
No time for
educationFamily
Pressure
Belief that you are
preventing sepsis
Fear of
litigation
Poor
communication
No support
from
executives
Off-site
prescribers
Limited
diagnostic
resources
Staff
Turnover
-Ron HeifetzThe Practice of Adaptive Leadership
“The most common cause of
failure in leadership is
produced by treating adaptive
challenges as if they were
technical problems.”
Reframe the Landscape.
To Err is Human published
DoD implements a patient safety program
Joint Commission established its National Patient Safety Goals (NPSGs) program
TeamSTEPPS program released
CUSP program developed and released
2000
2001
2002
20112006
Patient Safety Becomes a Priority
https://thenextweb.com/wp-content/blogs.dir/1/files/2010/08/idea_bulb.jpg
Hypothesis: Merging patient safety methodology with technical antibiotic
stewardship tasks will promote behavior change and enhance antibiotic
stewardship methods across the healthcare spectrum.
National AHRQ Safety Program for
improving antibiotic use
Spans the healthcare spectrum
• 250-500 Acute Care Sites
– December 2017 - November 2018
• 250-500 Long-Term Care Sites
– December 2018 – November 2019
• 250-500 Ambulatory Care Sites
– December 2019 – November 2020
14
May 11, 2018 15
Expected Outcomes
• Improve safety culture
• Enhance teamwork and communication
• Reduce unnecessary antibiotic use
• Improve antibiotic decision-making
• Reduce Clostridium difficile infection rates
• Improve compliance with new government
mandates
16
Thank you
• Sara Cosgrove
• Pranita Tamma
• Robin Jump
• Melissa Miller
• Meghan Walrath
• Mayo Levering
• Kathleen Speck
• TEP expert panel
• Jonathan Zenilman
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