Lecture 3 - Roles, Education, and Values of Healthcare Professionals, ABX Stewardship Flashcards
Differentiation must be balanced because _________
It can be counterproductive when activities of one functional unit must be coordinated with that of another
Integration
The degree to which harmony of effort exists among different units
Integration requires
- Interaction
- Sharing of information
- Joint decision making about goals
______________ is a tool for integration
Cross-Understanding
What are the 5 professions that are the largest in number involved in interprofessional delivery of healthcare:
- Medicine
- Nursing
- Pharmacy
- Social work
- Healthcare administration
O*NET Occupational Interest:
Realistic
Frequently involve work activities that include practical, hands-on problems and solutions
(Often deal with plants, animals, and real-world materials like wood, tools, and machinery. Many of the occupations require work outside and do not involve a lot of paperwork)
O*NET Occupational Interest:
Investigative
Frequently involve working with ideas, and require an extensive amount of thinking
(These occupations can involve searching for facts and solving problems mentally)
O*NET Occupational Interest:
Artistic
Frequently involve working with forms, designs, and patients.
(They often require self-expression and the work can be done without following a clear set of rules)
O*NET Occupational Interest:
Social
Frequently involve working with, communicating with, and teaching people.
(These occupations often involve helping or providing service to others)
O*NET Occupational Interest:
Enterprising
Frequently involve starting up and carrying out projects.
(These occupations can involve leading people and making decisions. Sometimes they require risk taking and other deal with business)
O*NET Occupational Interest:
Conventional
Frequently involve following set procedures and routines
(These occupations can include working with data and details more than with ideas. Usually there is a clear line of authority to follow)
Role:
Physician
- Diagnose illnesses, and prescribe and administer treatment for people suffering from disease
- Examine patients, obtain medical history, order and interpret diagnostic tests, prescribe drugs, perform surgery, manage chronic disease
- Obtained either an MD or DO degree
Education:
Physician
– Licensed on the state (as opposed to federal) level
• 3 USMLE exams plus USMLE CS plus intern year completion = medical license
– Most physicians are board certified-passed a test in their specialty (Needed for hospital privileges in some cases)
Values:
Physician
- Very independent
- Expect problems to have solutions
- Expect high social status
- Respect for scientific evidence
- Concerned about patient care > cost
Primary O*NET Interest: INVESTIGATIVE
Role:
Pharmacy
- Distribute prescription drugs to individuals for the treatment of disease in response to a prescription
- Advise patients, physicians, and other healthcare workers on the selection, dosages, interactions, and side effects of medications
- Monitor the health and progress of the patients they provide medications to ensure they are using their medications safely and effectively
Education:
Pharmacy
• PharmD is a 4 year graduate doctoral degree
• Some pursue a 1-2 year residency after graduation
• After completing their degree, pharmacists must pass 2 exams to attain state licensure
– One in pharmacy skills and knowledge
– Another in law of the state issuing the license
Values:
Pharmacy
- Excellence in the choice and dosing of drugs to treat patients
- Primary O*NET Interest: Investigative
What are the two exams pharmacist must pass to attain state license?
– One in pharmacy skills and knowledge
– Another in law of the state issuing the license
Antibiotic Resistance
Definition
A microorganism’s resistance to an antimicrobial drug that was once able to treat an infection by that microorganism
(One of the principal public health threats facing the world)
What are three ways resistance genes can transfer?
- Plasmid transfer
- Transfer by viral delivery
- Transfer of free DNA
What are the 6 characterizations of ONET
- Realistic
- Investigative
- Artistic
- Social
- Enterprising
- Conventional
Profession top two interest:
Internist
Investigative
Social
Profession top two interest:
Surgeon
Investigative
Realistic
Profession top two interest:
Registered Nurse, Nurse Practitioner, Social worker
Social
Investigative
Profession top two interest:
Pharmacist
Investigative
Conventional
Profession top two interest:
Heathcare Administrators
Enterprising
Conventional
Carbapenem Resistant Enterobacteriaceae
Gram negative bacteria that produce an enzyme called carbapenemase that confers resistance to carbapenem
(Includes the genera Klebsiella, Escherichia, and Enterobacter)
T/F
CRE bacteria can asymptomatically infect/colonize patients
True
Antibiotic Stewardship
Systematic measurement and coordinated interventions designed to promote the optimal use of antibiotics
(Includes choice, dosing , route, and duration)
Goal: optimize clinical outcomes while minimizing unintended consequences
T/F
Starting in 2017, the Joint Commission has mandated that all hospitals and nursing care facilities have antibiotic stewardship programs
True
Antibiotic Use Principles
5
- Empiric therapy - Start based on clinical evaluation
- Tailoring therapy - Change the antibiotics in response to clinical data like blood cultures
- Convert from IV to PO - Minimizes complications, saves money
- Use the shortest effective duration of therapy
- Monitor Pharmacokinetics (Ex: Vancomycin trough and dose adjusting)
CDC Core Elements of ASP
- Leadership Commitment: clear support from hospital leaders
- Accountability: physician to lead the team and responsible for outcomes
- Antibiotic Expertise: pharmacist
- Action: intervene to ensure abx used correctly
- Tracking: monitor abx use and track resistance
- Reporting: create reports on abx use and distribute to hospital
- Education: educate clinicians
The action that the ASP can take; typically includes the following strategies (2)
- Prospective Audit and Feedback (PAF): ASP staff review abx orders and provide recommendations to prescribers regarding optimization of abx use
- Preauthorization: approval is required by an infectious disease specialist before an abx can be administered
Microbiology Lab Function
- Cultures, grows, and identifies organisms
- Compiles antibiogram data (Summary of abx susceptibility data for bacterial isolates recovered by a the lab over a defined period of time)
- Makes decisions on diagnostic tools to use
- Susceptibility results are a useful tool for guiding abx use
