Treating hyperkalemia, good catches, legionella, and more in the September 2017 Pennsylvania Patient Safety Advisory
Harrisburg, Pa., September 25, 2017 — The improper use of antibiotics in long-term care facilities (LTCFs), specifically for the treatment of urinary tract infections (UTIs), can increase the risk of resident harm and contribute to the rapid emergence of antibiotic-resistant bacteria.
"Antibiotic-resistant organisms are not only a threat to the health of patients and residents, they're threat to everyone," said Dr. Ellen S. Deutsch, medical director for the Pennsylvania Patient Safety Authority.
"Antibiotics have saved the lives of millions of people, and now their effectiveness is under assault," said Deutsch. "The misdiagnosis of UTIs in LTCFs, which leads to the misuse and overuse of antibiotics, contributes to antimicrobial-resistance."
Antibiotics are the most commonly prescribed medication in LTCFs; however, they are prescribed incorrectly up to 75% of the time, according to national statistics. UTIs represent the most common bacterial infection in LTCFs, and due to the frequency of their misdiagnosis, largely contribute to the overuse and misuse of antibiotics.
From April 2014 through September 2016, Pennsylvania LTCFs reported 13,680 UTIs to the Authority. In examining antibiotic prescribing practices, Authority analysts found deviance from national practice guidelines for treating UTIs and suboptimal use of antibiotics.
Common misperceptions may result in inappropriate treatment, overuse of broad-spectrum antibiotics, and failure to review or change antibiotics following laboratory test results.
"Antibiotic resistance and other complications are a significant problem, and defeating this problem will take widespread and sustained effort," said Deutsch. "The appropriate management of UTIs and possible UTIs is an important piece of this large puzzle."
In the Authority's September 2017 Pennsylvania Patient Safety Advisory article, "Optimal Use of Antibiotics for Urinary Tract Infections in Long-Term Care Facilities: Successful Strategies Prevent Resident Harm," the Authority provides a comprehensive list of risk reduction strategies. Accompanying the article is the "Living Branches Urinary Tract Infection (UTI) Evaluation Guideline," a UTI evaluation tool adapted from the Pennsylvania Medical Directors Association (PMDA). Utilization of both the risk reduction strategies and the UTI evaluation tool may help facilities properly manage UTIs and implement a solid antimicrobial stewardship plan.
Download the full article.
Also published in this Advisory:
Treating Hyperkalemia: Avoid Additional Harm When Using Insulin and Dextrose
Hyperkalemia is a common, potentially life-threatening electrolyte disturbance encountered in hospitalized patients. Treatment of hyperkalemia with insulin and dextrose, without implementing clear protocols and error-reduction strategies, can lead to hypoglycemia and other patient harm.
Promote a Culture of Safety with Good Catch Reports
A hospital good catch program can be an effective means to improve patient safety. Recognizing and rewarding staff can encourage good catch submissions and provide more opportunities to improve patient safety.
Legionella: Could This Potentially Deadly Bacteria Be Lurking in Your Facility's Water Distribution System?
Preventing healthcare-acquired legionnaires' disease depends upon identifying possible sources where Legionella growth could occur and instituting control measures. Evidence-based risk reduction strategies may control and proactively prevent healthcare-acquired legionellosis.
Data Snapshot: Dislodged Tubes and Lines
Feeding tubes, intravascular catheters, and other tubes and lines are routinely and safely used in healthcare, but tubes or lines that become dislodged can have fatal consequences, depending upon the type of tube or line used and how quickly the dislodgement is recognized and treated.
Workarounds: Trash or Treasure?
An enlightened understanding of workarounds can help healthcare facilities appreciate that workarounds are symptoms of a real or perceived workflow obstacle, and value the information that workarounds provide.
For more information about the Authority, patient safety topics, Advisory articles, and safety tips for patients, please visit patientsafety.pa.gov.
The Authority's mission is to improve the quality of healthcare in Pennsylvania by collecting and analyzing patient safety information, developing solutions to patient safety issues, and sharing this information through education and collaboration. Its vision is safe healthcare for all patients.