It is that time of year again. The time of year when the cold weather drives everyone inside, where they huddle together with their electronic device of choice. They hack, sneeze, and cough passing the micro-organisms back and forth to one another until things warm up in April or May. There are two big questions that every hospice nurse should be asking right now:
- Are these symptoms a true infection or a change in condition?
- Is this infection viral or bacterial?
The answer to these two questions means potential adverse drug events prevented, quality of life sustained or improved, and money saved.
Is it an Infection or a Change in Condition?
Often it is difficult to differentiate between a change in condition and infection in the elderly, especially if they are frail, bed bound, or have an underlying condition. There is a short checklist of items that can help determine if an infection is present:
- Are ALL symptoms new or worse than baseline?
- Is there a possible non-infectious cause for the symptom(s)?
- Is there more than one sign or symptom indicating an infection?
To assist in answering the last item, there are a few guidelines or surveillance definitions that help identify those patients who truly have an infection. The link to three of them are below:
CDC Surveillance Criteria
APIC- Surveillance Definitions for Home Health and Hospice
McGeer Criteria for Long Term Care
Is it a Virus or a Bacteria?
Once an infection is confirmed, the cause must be identified. Whether it is viral or bacterial will determine treatment and symptom management. In most cases, antibiotics are not warranted. A recent JAMA study found that 60% of adults seen for a sore throat received an antibiotic prescription, however only 10% of them actually had strep and required antibiotic treatment. An easy rule of thumb to determine viral or bacterial:
Viral infections: Symptoms spread throughout the body and fever is high in the beginning then decreases.
Bacterial infections: Symptoms are localized to the infected area (tonsils, lungs, bone) and fever starts low then spikes days later.
Take extra time this cold, flu, and pneumonia season to determine if an antibiotic is truly needed. Doing so will save the patient unwanted side effects and save the hospice agency unwanted costs. It is a win-win situation.