As we enter cold and flu season, a familiar phenomenon also reappears: lines of patients with running noses and sore throats, pleading with physicians for an antibiotic prescription.
Most of them don't realize that antibiotics are ineffective against colds, the flu and other common viral infections. They assume that antibiotics are going to make them feel better.
Unnecessary antibiotic prescriptions are common. In Canada, estimates indicate that 30-50 percent of prescriptions are unnecessary. Statistics in the US are similar; the CDC estimates that at least 30 percent of prescriptions are inappropriate.
Though individually they may seem insignificant, each of these inappropriate prescriptions is contributing to growing rates of antimicrobial resistance, worldwide.
Drug-resident bacteria have been linked to 700,000 deaths each year, globally, according to the World Health Organization. In the US alone, the number of associated deaths is estimated at 23,000.
The difficult reality is that the drugs that we have relied on for over 70 years, are no longer as effective at fighting off infectious organisms - and as antibiotic resistance grows, our ability to treat common diseases is threatened.
A rallying cause
One of the most difficult challenges in antibiotic stewardship programs is that they need to be a unified effort. In part, that means empowering staff across the organization with the knowledge and tools they need to reinforce responsible prescribing, monitor alerts and have sometimes difficult conversations with patients.
- Make enforcing CDC guidance for infection detection, prevention, tracking and reporting a requirement.
- Ensure that your lab has the technology and personnel they need to accurately identify infections and alert clinicians and infection preventionists when bacteria are found.
- Be aware of infection and resistance trends in your organization, and those nearby.
- Ensure safe transfers by notifying staff at the receiving facility about all infections.
- Get involved with regional infection prevention efforts.
- Promote wise antibiotic use.
But what about the difficult task of addressing patient concerns? Choosing Wisely Canada, a member of the international Choosing Wisely campaign to reduce the use of unnecessary medical tests and treatments, recommends the following strategies:
- Take the time to talk about it. Reinforce the decision to not provide antibiotics by providing a reasonable explanation and alternatives for symptom relief and reassurance that patients can always come back.
- Use a delayed prescription. Providing a delayed prescription means that there is a good chance that the patient will be on the mend before they can fill it.
- Provide information. Make reading materials readily available to help spread awareness about the appropriate use of antibiotics and risks associated with improper use.
Providing adequate support for frontline staff is particularly important when it comes to overcoming “decision fatigue” – a phenomenon that sets in for physicians who spend their day saying no to patients asking for prescriptions. US Research indicates associates decision fatigue with higher rates of antibiotic prescribing later in physicians’ work days.
Be aware. Be engaged.
Ensuring that all healthcare professionals are aware of the importance of antimicrobial stewardship should be a top-priority all year, but cold and flu season is an excellent opportunity for targeted reminders about how they can play a part in fighting antimicrobial resistance. Whether it’s effective surveillance, actively following up on alerts or educating patients about how to take antibiotics properly, everyone has a role to play.
What's the biggest challenge you face in aligning your organization with your antibiotic stewardship efforts? Tell us in the comments below.
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