Healthcare professionals engaged in Huron's Team Approach to Antibiotic Stewardship

From allergy season to flu season and beyond, the common symptoms of a stuffy nose, cough and sore throat lead many individuals to their local clinic in search of relief. The presence of a fever increases the possibility of a bacterial infection; but often the culprit is a virus, which requires time instead of prescription medication.

A variety of antibiotics have long been relied on to effectively treat bacterial infection. Using these valuable medications for extended periods, or for a viral instead of a bacterial infection, will actually reduce the effectiveness and result in the growth of antibiotic-resistant bacteria.

Dr. Robert Hohm, Tschetter and Hohm Clinic, Huron, SD

After 41 years of medical practice, the rise in drug resistant bacteria has been overwhelming. Simple infections can be more worrisome and problematic than ever before,” explained Robert Hohm, MD, internal medicine physician at Tschetter and Hohm Clinic in Huron, SD.

 

Our antibiotic stewardship group in Huron, SD, is working very hard, and diligently, to break the ‘culture of expectations’ when it comes to treating viral infections,” stated Jesse Van Heukelom, MD, from Huron Regional Medical Center Physicians Clinic. “Approximately 23,000 patients are dying each year in the United States as a direct result of antibiotic resistant infections. Unfortunately, this number will only grow.”

Despite the inability to fight viral infections, antibiotics’ reputation for relieving symptoms resulted in a growing demand by healthcare consumers.

Van Heukelom commented, “We must make smart choices in prescribing as well as consuming antibiotics. Medical providers need to take a little more time to explain the reasons why antibiotics are not necessary, and the patients must be willing to go away from a visit with no antibiotic and use supportive care for their viral infections.”

Educating consumers regarding the value of prevention and purpose of antibiotics is part of antibiotic stewardship. Dr. Hohm emphasized, “Precautions can be made to reduce the spread of infections such as hand washing, covering coughs, protecting wounds with appropriate bandages. Getting preventive immunizations, such as the influenza and pneumococcal vaccines, can help reduce the spread of infections in our community and in the nation as well.”

Cheri Fast, RN, BSN, WOCN, program manager for Great Plains QIN, has been working with Dr. Hohm and other healthcare professionals in Huron, SD, to promote antibiotic stewardship efforts. Huron, with a population of just over 13,000, boasts a robust and unique healthcare community including a critical access hospital, a federally qualified health center and various independent providers serving a diverse demographic.

Fast gathered prescription data from local retail pharmacies, which indicated the number of antibiotic prescriptions had nearly doubled between 2016 and 2017. The resulting conversation with a few providers has now grown into a community-wide effort and an overall decline of the dispensing of antibiotics by 28% over last year.

Leonard Wonnenberg, PA-C, from Horizon Health Care’s James Valley Community Health Center was among those joining the conversation. “This community project has been, and will be, a great community resource for my clinic, my patients and myself, as a provider and a patient. By collaborating with different healthcare professionals in the Huron area, the relationships we have made thus far and, hopefully will make in the future, will have a very positive impact for years to come.”

“Most people go to see their healthcare provider when they are sick, and they expect to get something that will make them better,” stated Danielle Rathjen, nurse practitioner at Tschetter and Hohm Clinic in Huron, SD. “For certain illnesses, such as the common cold and bronchitis, the antibiotics patients frequently request will not help them fight the virus that is causing their symptoms.” Rathjen often recommends over-the-counter medications or the “tried-and-true” home remedies including warm tea with honey, saline rinses and saltwater gargles to relieve symptoms of these common viruses. “It takes time to educate patients, but I have found patients are often happy to know they are not being given antibiotics unnecessarily. As more and more antibiotics are prescribed, our bodies can become less sensitive to these medications and they may not be effective in the future,” added Rathjen. Rathjen has added antibiotic justification to her electronic medical records to assist her with appropriate prescribing and also using the viral prescription pads.

Elliot Hinricher, RPh, Huron Regional Medical Center

A laboratory test is the only sure way to determine if an infection is bacterial or viral. Elliot Hinricher, RPh, at Huron Regional Medical Center explained, “When your healthcare provider is able to identify what bacteria are growing from a laboratory sample, they also need to make sure you are on the best antibiotic to fight those bacteria. If your physician does not think you need an antibiotic, do not pressure them into prescribing one for you. Trust their professional judgement.“

Antibiotics can save lives, but we need to use them appropriately and responsibly. Patients should work with the providers to take part in antibiotic stewardship,” added Lois Truh, MD, of Truh Clinic in Huron, SD.

Next steps include the development of an antibiotic prescribing guide using an antibiogram to ensure that patients are getting the right antibiotic for the right diagnosis and lessen our resistance to antibiotic resistant bacteria. According to Fast, we have a good start but have a long way to go. We will continue to reach out to all providers, clinics, nursing homes, assisted living centers, schools, and dentists. We have also been educating consumers by raising awareness on social media, newsletters, bulletin boards, and articles. At the SD Women’s Expo, 425 community members signed an ‘Antibiotic pledge’. Those that committed to the pledge, were put in a drawing for Huron Bucks.

This pledge states:

  1. I will take my antibiotics as ordered.
  2. I will not skip doses.
  3. I will not save unused pills for future infections.
  4. I will not share with others.
  5. I will report side effects to my provider.
  6. I will use good hygiene to prevent infections. (Wash hands, cover coughs)
  7. I will get immunizations as recommended.
  8. I will not pressure my provider for antibiotics.

Donna Meier from Huron and her daughter, Deb VanOverschelde from Cavour were eager to take the pledge and commit to the safe and appropriate use of antibiotics. Donna even received her influzena vaccine from Coborns Pharmacy. She knows the importance of protecting herself and others and preserving our antibiotics.

Antibiotics are a precious resource and preserving their usefulness will require cooperation and engagement by all. Great Plains Quality Innovation Network (QIN) is partnering with practitioners, pharmacists and system leadership as well as consumers to slow antibiotic-resistance bacteria and prevent the spread of resistant infections. If you have questions or would like more information, contact Cheri Fast at cheri.fast@area-a.hcqis.org or call 605/354-2553.