Overutilization of Antibiotics in the Outpatient Wound Care/Hyperbaric Program

  • Laura Josefsen, RN, ACHRN
  • Volume 08 - Issue 2

“If you cannot measure it, you cannot improve it.”

— Lord Kelvin

It is known that antibiotics are necessary and save lives. It is also known that the overutilization and/or inappropriate use of antibiotics may result in drug-resistant bacteria that can lead to complications resulting in less-than-optimal outcomes for the patient as well as in increased costs. The issue of antibiotic overutilization has become a national priority for patient safety by governmental health-care agencies.

Antibiotic stewardship programs (ASPs) are quality- improvement processes to gather data to evaluate and determine evidence-based practice guidelines to better define diagnostic criteria for antibiotic use. These data include the following:

  • Assessing wound

  • Obtaining wound cultures

    • Determine whether wound is colonized or infected.

    • Perform cultures prior to antibiotic use.

    • Ensure wound culture is not contaminated.

  • Monitoring the antibiotics being prescribed

    • Recommend pharmacy oversight.

  • Utilizing antibiotic time-out after 48hours

    • Determine correct antibiotic per culture result(may need specific antibiotic).

    • Determine if wound is multiply infected (may need broad spectrum antibiotic).

    • Determine if modifications are needed.

  • Administering antibiotic medication by nursing staff

    • Education for patient

  • What to expect from medication — drug action and side effects

  • Indications

  • Correct dosage

  • Right of administration

  • Have automatic stop orders in place

  • Monitoring patient compliance

  • Nursing assessment includes the following:

    • Medication list, medication reconciliation

    • Allergies and allergy reconciliation

    • Culture results monitored to ensure antibiotic

    • Change in condition or adverse reaction to antibiotics monitored for patient

  • Ongoing assessment of the patient and the wound

    • Wound healing progress

  • Determine when wound is no longer infected
  • Recommended system for evaluating data:

  • A physician leader

  • Leadership commitment

  • Education

    • Patient education

    • Regular updates on data

    • Transparency of ongoing results with clinical staff

    • Ensuring staffcompetencies

      • Wound cultures
      • Understanding colonization vs.infection
  • Chart reviews — current and retrospectivefor completeness of information above

  • Development of clinical pathways

Patient safety is the primary goal for the process of ASPs. Now is the time to be proactive in developing this process for your unit as data are being  gathered  around  the nation to provide evidence-based practice guidelines for antibiotic use.


Centers for Disease Control and Prevention. Measuring outpatient antibiotic prescribing. Updated March 22, 2017. Available

at: https://www.cdc.gov/getsmart/community/programs- measurement/measuring-antibiotic-prescribing.html

Centers for Disease Control and Prevention. Outpatient antibiotic prescriptions: United States, 2014. Available at: https://www.cdc.gov/getsmart/community/pdfs/annual- reportsummary_2014.pdf

Drekonja D, Filice G, Greer N, Olson A, Wilt T, MacDonald R, Rutks I. Antimicrobial stewardship programs in outpatient settings: a systematic review. VA-ESP Project #09-009.

Washington, DC: Department of Veterans Affairs; February 2014. Available at: https://www.hsrd.research.va.gov/ publications/esp/antimicrobial-outpatient-EXEC.pdf

Sanchez GV, Fleming-Dutra KE, Roberts RM, Hicks LA. Core elements of outpatient antibiotic stewardship. MMWR Recomm Rep. 2016;65(No. RR-6):1–12. Updated November 10, 2016. Available at: DOI: http://dx.doi.org/10.15585/mmwr. rr6506a1


About the Author


LAURA JOSEFSEN, RN, ACHRN, has been involved in hyperbaric nursing since 1982. A founding member of the Baromedical Nurses Association (BNA) in 1985, she served as BNA president from 1996 to 1998 and as a board member in several positions throughout the years. She served on the Undersea and Hyperbaric Medical Society (UHMS) Associates Council for six years, with two of those years as Nurse Representative on the UHMS Board of Directors. She has been a member of the UHMS Accreditation Team as a nurse surveyor, served for many years as an executive board member of the National Board of Diving and Hyperbaric Medical Technology and is a previous chairman of the BNA Certification Board. She is a member of the UHMS Associates, former member of Divers Alert Network, and former member of the Hyperbaric Technologists and Nurses Association (HTNA) of Australia. She has numerous publications and is an internationally recognized speaker in the field of hyperbaric medicine.

Her passions are quality improvement and education to promote hyperbaric nursing, safety, and optimal standards of care and practice for patients and the community.


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