Antibiotic stewardship — embrace the change
Jacqueline Vance, RNC, CDONA/LTC
OK, I get it. Not all change is good. For example, my Waze app was suddenly possessed by an evil spirit and changed its voice from English (UK) gentleman to Boy Band.
It was a change I did not like one bit. I happen to like my UK gentleman's voice that enunciates each word so carefully and politely tells me where to go. (Behave, my readers!) This was a change I could re-program back to my original choice.
However, antibiotic stewardship is a change you need to embrace. You can't just say I prefer it the old way, give everyone an antibiotic who asks for one and that will be that. But I get it. You are willing to change, but sometimes the residents and their families aren't.
I keep picturing a conversation in my head that kind of goes like this:
Patient's daughter: You need to give my mom an antibiotic because last time she acted this way she had a UTI.
Me: What behavior is that?
Patient's daughter: Mom told me I was gaining weight.
Me: (Thinking ... Control your impulse, Jackie!) No, your mom has dementia and has no impulse control and she unfortunately says what is on her mind. However, she has no clinical signs or symptoms of a UTI. A mental status change by itself is not a symptom.
Patient's daughter: I don't care what you say. I am her daughter and I know her better that you all and she needs antibiotics.
Me: So you want your mother to have infectious diarrhea? Like massive, colon-blowing diarrhea? I mean, you've seen a race car go from 0 to 60 MPH in five seconds, right? So, like, your mom's butt would be the exhaust pipe on that car. She would actually be praying for a seat belt on the toilet so she doesn't blow off of it. That's what you want?
... OK, so I guess I can't really have that conversation, but how about this one?:
Patient's son: You need to give my dad an antibiotic because last time he acted this way he had a UTI.
Me: I know you said your dad is not quite himself, but a mental status change by itself is not a symptom of a UTI. The nursing staff as well as his doctor fully assessed your dad and he clinically does not meet any criteria for an infection.
Patient's son: I don't care what you say. I am his son and I know him better than you and he needs an antibiotic.
Me: Ok, let's step back a minute. What do you do for a living?
Patient's son: I am an electrician. I wire homes for electricity.
Me: So, if the doctor told you he saw a show on HGTV where they were refurbishing an old home and rewired it, and she told you how to wire a home, would you do it her way?
Patient's son: Of course not. She's not an electrician.
Me: Great. The doctor didn't go to electrician school and you didn't go to medical school or nursing school. So how about if you trust the people who did go to school for this to make the clinical judgment? I promise you, we will monitor him every shift, and if he does show and symptoms, I assure you we will act appropriately on them.
... Think that will work? Naaaah. I'm sticking with explosive diarrhea instead of being rational!
Just keeping it real,
The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, an APEX Award of Excellence winner for Blog Writing. Vance is a real life long-term care nurse. 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.