meet my mom: the peggy lillis story · why antibiotic stewardship trends in antibiotic resistance...

Meet My Mom: The Peggy Lillis Story

March 16, 2018

2018 KHA Annual Quality Conference

The Stakes…

9,967

13,712

23,000

29,000

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

US Deaths 2014

Drunk Driving

HIV/AIDS

AROs

C. diff

Who Was Peggy?

Peggy’s C. diff Story

Broad spectrum antibiotic

following root canal

Symptoms begin 5 days

into course

Suspected stomach virus

Admitted to hospital 5

days after diarrhea onset

Died 36 hours later

Lessons from Peggy’s Story

Antibiotic Overuse (Prophylaxis)

Lack of C. diff Awareness

Persistence of C. diff Myths

No warning from prescriber

Danger of Prescribing Imodium

Learning from Patient Stories

Stories help engage patients by:

Illustrating the benefits and risks of

antibiotic usage

Humanizing statistics

Breaking through mythology

Highlighting opportunities for shared

decision-making

Why Antibiotic Stewardship

Trends in Antibiotic Resistance→ In 2013, CDC identified 3 Urgent Threats

→ 2 million infections and 23,000 deaths

Overuse and mis-use→ 266 million prescriptions in 2014

→ 30% of oral antibiotics are unnecessary

The C. diff epidemic→ 500,000 infections and 29,000 deaths

Fluoroquinolone Toxicity

Microbiome Disruption

The Disconnect

Cycle of Blame

Patients don’t see downside

Doctors fear missing a

dangerous infection

Antibiotic-related harm

is hidden from public

Antibiotic Resistance =

Climate Change

Changing The Conversation

Doctors must treat antibiotics like any

other prescription drug

→ Chemotherapy or Opioids

→ Imperfect analogies

Informed consent: Share benefits AND

risks with patients and caregivers

Offer methods for symptom relief

Be Proactive

Proactive Strategies

Integrate Patient Stories about Adverse Events from

Antibiotic Usage

Facility-wide US Antibiotic Awareness Week Events

Include Stewardship messages in Patient Safety Week

Activities

Have Patients/Caregivers Serve on AS Committees

Share Your Practice’s Orientation Toward Antibiotics with

New Patients

Include information on antibiotics in patient materials

Provider Resources*

CDC’s Get Smart About Antibiotics Campaign

→ US Antibiotic Awareness Week*

→ March 2014 Vital Signs*

Joint Commission New Antibiotic Standard

APIC Antibiotic Stewardship

National Quality Partners Playbook: Antibiotic

Stewardship in Acute Care

IDSA Faces Of Antimicrobial Resistance

PLF Advocates Council Videos*

Pew Antibiotic Resistance Project

→ Why Doctors Prescribe Antibiotics—Even When

They Shouldn’t

→ What Drives Inappropriate Antibiotic Use in

Outpatient Care?

→ Unnecessary Antibiotic Use and Patient Safety

Choosing Wisely

Patient Resources

PLF Patient Brochure in English and

Spanish

PLF C. diff Stories

CDC – The Other Side of Antibiotics

video

Choosing Wisely→ Antibiotic Treatment in the Hospital

→ Antibiotics for people with catheters

→ Antibiotics: Will They Help You or Hurt You?

→ Colds, flu, and other respiratory illnesses in adults:

When you need antibiotics—and when you don’t

→ 7 others based on illness

Official Estimates = Tip of the Iceberg

29,000 deaths

according to CDC

108,000 deaths

2008 prevalence

study

Nursing Home Deaths

(Unreported)

Community Deaths

(Unreported)

Unreported Deaths

No C. diff!

Making C. diff Count

Require C. diff and other HAIs to be recorded on death certificates

Modernize Nationally Reportable Disease Laws

Expand and Update State Public Reporting Laws

Increase Funding at Federal and State Level

Other Areas for Collaboration

Research for prevention (CDC, vaccines) and treatment

(Ebiotics, FMT, etc.)

Raising awareness of underutilized treatments (FMT and

Fidaxomicin)

Advocating for increased public and private funding

Patient education (particularly around antibiotic overuse

and HAI risk factors and symptoms)

“All you have in this world is each other.”

- Peggy Lillis

Peggy’s Vision

A World Where C. diff is Rare, Treatable &

Survivable.