Enhancing the Safety of Hospitalized Patients: Who Is Minding the Antimicrobials?

Flanders, Scott A.; Saint, Sanjay

doi:10.1001/archinternmed.2011.595

Cited by 6 publications

(4 citation statements)

References 11 publications

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“…One common theme of these diverse and successful strategies is that they engendered medical mindfulness, or making a thoughtful clinical decision, rather than reflexive use of antibiotics. 81-82 Our ongoing intervention, entitled “Kicking CAUTI: the No Knee-Jerk Antibiotics Campaign,” encourages clinicians to stop and think before ordering cultures and prescribing antibiotics for catheter-associated bacteriuria. 83 The two main tools used in the intervention are (1) an evidence based, actionable algorithm that distills the guidelines into a streamlined clinical pathway and encourages a mindful pause (Figure 1), 9 and (2) case-based audit and feedback to train clinicians to use the algorithm.…”

Section: Management Of Asbmentioning

confidence: 99%

Approach to a Positive Urine Culture in a Patient Without Urinary Symptoms

Trautner

Grigoryan

2014

Infectious Disease Clinics of North America

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Asymptomatic bacteriuria (ASB) is a condition in which bacteria are present in a noncontaminated urine sample collected from a patient without signs or symptoms related to the urinary tract. ASB must be distinguished from symptomatic UTI by the absence of signs and symptoms compatible with UTI or by clinical determination that a nonurinary etiology accounts for the patient's symptoms. ABU is a very common condition that is often treated unnecessarily with antibiotics. Pregnant women and persons undergoing urologic procedures expected to cause mucosal bleeding are the only two groups with convincing evidence that screening for and treating ASB is beneficial. Randomized, controlled trials of ASB screening and/or treatment have established the lack of efficacy in premenopausal adult women, diabetic women, patients with spinal cord injury, catheterized patients, older adults living in the community, and elderly institutionalized adults. The overall purpose of this review is to promote an awareness of ASB as a distinct condition from UTI and to empower clinicians to withhold antibiotics in situations in which antimicrobial treatment of bacteriuria is not indicated.

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Section: Management Of Asbmentioning

confidence: 99%

Approach to a Positive Urine Culture in a Patient Without Urinary Symptoms

Trautner

Grigoryan

2014

Infectious Disease Clinics of North America

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“…3 To improve clinician competency, presentmoment awareness has been introduced in the primary care setting, 4 control of cognitive biases through mindful practice has been proposed to reduce diagnostic errors, 5 and thoughtful decision making has been recommended to prevent urinary tract infections. 6 In one of the most extensive discussions of applying mindful practice within healthcare, Epstein defined mindfulness as "attending to his or her own physical and mental processes during ordinary everyday tasks to act with clarity and insight" 7(p833) and explained how mindfulness can support evidence-based practice. Ludwig and Kabat-Zinn 8 also support mindfulness as a way to improve quality of care but recognize a lack of consensus as to a working definition of mindfulness and a lack of knowledge about how mindfulness might work.…”

Section: Infect Control Hosp Epidemiol 2013;34(10):1099-1101mentioning

confidence: 99%

Applying Mindful Evidence-Based Practice at the Bedside Using Catheter-Associated Urinary Tract Infection as a Model

Kiyoshi‐Teo

Krein

Saint

2013

Infect. Control Hosp. Epidemiol.

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“…Similarly, Tedja et al found that 6% of all CAUTI cases grew the same organism in both blood and urine cultures. A third consideration would be to measure the incidence of NHSN-defined CAUTIs in which the patient received antibiotics targeting the urine culture results 12 . Such a revised metric would have the added benefit of discouraging treatment of asymptomatic bacteriuria, a common reason for antibiotic misuse.…”

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confidence: 99%