Ask the Care Expert about ... ordering antibiotics

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Sherrie Dornberger, RN, CDONA, FACDONA, Executive Director, NADONA
Sherrie Dornberger, RN, CDONA, FACDONA, Executive Director, NADONA

I am trying to train some of the staff on my floor to be aware before simply automatically ordering an antibiotic to get the resident feeling better. Can you help?

The Centers for Disease Control and Prevention has developed seven core elements to consider: Leadership Commitment, Accountability, Drug Expertise, Action, Tracking, Reporting and Education.

Of the more than 4.1 million Americans in a nursing home annually, about 70% have received an antibiotic and 75% of those have been prescribed antibiotics incorrectly.

It could mean you've requested an order for an antibiotic because a resident has burning upon urination and have done so prior to urine culture and sensitivity test being done. Or maybe the resident had received the antibiotic for four days and you get the results of the C&S, and find the organism was found in the urine. (The drug was ordered incorrectly.)

Another scenario: Some antibiotics should not be given with foods, yet one was ordered and given at mealtime. Or maybe it should not be given with antacids, but the resident states the antibiotic makes her nauseated, so some antacid is given with the antibiotic. Then this qualifies as being administered incorrectly.

The CDC's cost estimates of antibiotics in nursing homes range from $38 million to $137 million and adds that residents receiving higher antibiotic use have a 24% chance of increased risk of harm. 

Even residents in nursing homes who do not receive antibiotics are still at an increased risk of indirect antibiotic related harm due to the spread of resistant bacteria or C. Diff germs.

On www.CDC.gov you will find good information to assist with antibiotic resistance.