Just say NO — to giving in to patients
Jacqueline Vance, RN
A recent WebMD/Medscape survey conveyed that it might be clinicians' antibiotic prescribing habits that are contributing to the public health crisis of antibiotic resistance. The survey found that about 1 in 4 patients ask their clinician for an antibiotic, and despite not clinically needing it, the clinician often acquiesces to the request.
According to the CDC, antibiotic resistance causes more than two million people to become infected with an antibiotic resistant bacteria a year and about 23,000 deaths in the United States.
OK, I'm just going to say it: Nurses in long-term care are really guilty here as well. You know what I mean.
That survey-defense mentality of insisting on a urine culture with only a mental status change that was not needed because there were no systemic symptoms of infection. (See # 3 here.)
Then, when we get back the culture with a bacterial count of less than 100,000, we still call the clinician and insist on him or her prescribing an antibiotic.
Why? Because we've been conditioned to think we'll be “dinged” if we don't. Kids, this isn't Avon calling and if you have surveyors who are that uninformed of evidence-based practice, you can educate them. Show them the evidence that exists to NOT treat.
But better yet, don't ask for the dag-gone culture in the first place. You know that saying about making a bed right.
And that goes for not giving in to family pressure either. I mean, if they told you to give Mom a huge shot of insulin and she isn't diabetic, would you? Of course not! It wouldn't be right. It's time to choose wisely.
I picture a movie in my head, looking pretty much like the scene from “The Matrix” when Morpheus asks the main character Neo to choose between a red pill and a blue pill. But this is with Morpheus asking a nurse to choose between asking a clinician for a culture or an antibiotic without clinical evidence.
Morpheus: This is your last chance. After this, there is no turning back. You take the blue pill — the patient gets an unnecessary culture and subsequent antibiotic and you get to believe whatever you want to believe. You take the red pill — you become enlightened, and you don't ask for a culture but ask for the clinician to come in and do a medically necessary visit to see why the patient is having problems in the first place. Remember, all I'm offering is the truth — nothing more.
Nurse: (Her expression is anxiety; a sheen of sweat on her face, fear of making the wrong choice in her eyes, as we hear her thoughts.) I want the truth. I can make clinicians come in and diagnose their patients. I can state my case with surveyors. I will do what's best for my patient and the whole of the USA. (Confidently now stating out loud:) I choose the red pill!
Morpheus: You have chosen wisely!
OK, so maybe I shouldn't watch the Matrix and eat and entire bowl of guacamole before bed, but you get my point!
Just keeping it real,
The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, a 2012 APEX Award of Excellence winner for Blog Writing. Vance is a real life long-term care nurse who also is the director of clinical affairs for AMDA – The Society for Post-Acute and Long-Term Care Medicine. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. She has not starred in her own national television series — yet. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates.