Daily Editors' Notes

An easy way to reduce antibiotics

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Elizabeth Leis Newman
Elizabeth Leis Newman

Blame Chicago's cold weather, or the questionable cleaning practices of my gym, but this month I've had the immune system of a toddler. It is tempting to run to my internist and beg for an antibiotic to stem what could be a sinus infection, but is more likely, much like the polar vortex, a cold that won't go away.

I was reminded of the need to hold back by a new study in JAMA Internal Medicine that reminds us that nearly half the antibiotic prescriptions given for respiratory infections are incorrect, as the majority of the diseases in question are viruses. An antibiotic given to someone with a virus doesn't make the person feel better, except possibly emotionally, but it does put him or her at risk for antibiotic-resistant illnesses such as C. diff.

Researchers have come up with a way to empower physicians to stop prescribing medications, which could save more than $70 million in drug costs. It's having them sign a commitment letter, and post it in the office, which researchers found lowered inappropriate prescriptions by 10 percentage points. The control group, on the other hand, saw their level of inappropriate prescription of antibiotics rise from 43.5% to 52.7%.  If you cannot convince your emergency room hospital partners to look into this, you can consider it for your skilled nursing facility and the physicians who practice there.

"This intervention is a unique addition to interventions that have decreased inappropriate antibiotic prescribing for respiratory infections. Most other interventions have been focused on reminders or education and this is a novel, low-cost approach," said Jeffrey A. Linder, of Brigham and Women's Hospital and Harvard Medical School.

The JAMA results come on the heels of researchers recommending that nursing homes change their definition of fever. Essentially, everyone assumes that 98.6 degrees is standard, but the researchers recommend documenting what is “normal” for the resident in an effort to reduce antibiotic prescriptions. That's one of those stories that I know many readers looked at and rolled their eyes, thinking, “Ain't nobody got time for that.” But in many cases, the resident's “normal temperature” was lower than the standard, which means a resident who is clocking in with a mild 99.5 may be in more trouble than believed.

Both of these initiatives require discussion among administrators and nurses, and they take time. But the results may increase quality of care for residents, or possibly even halt a fatal outcome.

Elizabeth Newman is the Senior Editor at McKnight's. 

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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