December 2018
HHQI's Underserved Populations (UP) Network monthly newsletter
Quarterly UP Network Webinar | January 17, 2019 | 2-3 p.m. ET

Lower-Literacy Approaches:
Working with People with Dementia
For patients with cognitive impairment and their caregivers, barriers can be further complicated by literacy issues. It’s up to us, as healthcare professionals, to identify these issues and adjust our methods to ensure that each and every patient gets the very best care.

In this webinar, you’ll learn how to approach lower literacy issues among your patients. You’ll also discover tools for managing challenging behaviors associated with Alzheimer’s disease and related dementias. Register here .
Debra Cherry, BA, MA, PhD  
Executive Vice President

Jennifer Schlesinger, MPH, CHES
Director of Professional Training and Healthcare Services
This activity has been submitted to Alabama State Nurses Association for approval to 
award 1.25 Nursing contact hours. Alabama State Nurses Association is an accredited approver of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation (ANCC).

To receive CE credit, participants must watch the webinar and enroll in the corresponding course in HHQI University's   Underserved Populations   course catalog to complete related coursework. 

Step-by-step instructions   will be reviewed at the end of the webinar.
Now Available:
October 2018 UP Network Webinar Recording

In HHQI's last UP webinar, Promoting Medication Adherence at Home , Dr. Martha Sanders and Dr. Tracy Van Oss shared ideas to improve medication management and adherence related to cognitive techniques, adaptive equipment, and the use of occupational therapists. The webinar recording is now available, and you can still earn free nursing continuing education credits when you complete to corresponding course in HHQI University .
Save the Dates: 2019 UP Network Webinars

All webinars will be held from 2-3 pm ET.  As soon as details and registration are available, they will be accessible via the  UP page  on the HHQI website and emailed directly to those who are subscribed to our  UPDate and Educational & Networking Opportunities mailing lists .
Home health agencies (HHAs) care for populations of patients who are at risk for serious infections. For certain infections, early recognition is critical to avoid serious consequences, including death. Awareness and education is essential for clinicians and for patients and their families. In this issue of the UPDate, antimicrobial resistance and sepsis will be highlighted.

Antimicrobial Resistance (AR)

The Centers for Disease Control and Prevention ( CDC ) defines AR as, “when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them” ( CDC , 2013). Two common examples seen in home health for decades are Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant Enterococcus (VRE).

AR is one of the most serious health threats according to the CDC (2013). Did you know that the first commercialized antibiotic was discovered in 1928 by Alexander Fleming? AR began to appear in 1940 and continues to occur almost always within the same year that a new antibiotic is released since the 1990’s. Check out CDC’s Timeline of Antibiotic Resistance Compared to Antibiotic Development .

The CDC published a comprehensive analysis of the top 18 antibiotic-resistant threats (bacteria and fungi) in the U.S. in 2013. At that time, at least 2 million people developed an antibiotic-resistant infection and 23,000 people died (CDC, 2013). Clostridioides difficile (new name for Clostridium difficile or C. difficile ) caused almost 250,000 hospitalizations and 14,000 deaths from the infection annually. The use of antibiotics is a major contributing factor for the AR infections.

The 18 threats ranked into three categories based upon the level of concern to human health. Currently, the CDC is working on releasing an updated AR Threats Report in the fall of 2019.

Top 18 Antibiotic-Resistant Threats (CDC, 2013)  

Urgent Threats:

Serious Threats:

Concerning Threats:

Why is AR important? Some home health patients are at a higher risk for developing infections and need antibiotics to be effective and not produce more harm. This can include patients with chronic diseases (e.g., diabetes, asthma, rheumatoid arthritis), joint replacements, other complicated surgeries, organ/bone marrow transplants, dialysis for end-stage renal disease, and those receiving cancer therapy (CDC, 2013). Patients with infected wounds can develop an osteomyelitis with an AR organism. HHAs often provide home intravenous (IV) therapy for these patients where there are a limited number of effective drugs and AR is possible.
Home Health's Role with Antimicrobial Resistance ( AR )
Inpatient settings and physician practices have been working on responsibly ordering antibiotics, preventing infections, and educating patients. Awareness about antibiotic appropriateness and AR needs to occur with staff, patients, and families. Winter is a great opportunity to share information about treatment of cold/flu symptoms and the limited role of antibiotics. Many people expect to be prescribed an antibiotic but don’t understand the risk of taking them when it isn't necessary. Utilize the CDC’s Chart: Viruses or Bacteria – What’s Got You Sick? with patients.
The CDC (2017) has seven facts for you to Be Antibiotics Aware :

  1. Antibiotics save lives. When a patient needs antibiotics, the benefits outweigh the risks of side effects or antibiotic resistance.
  2. Antibiotics aren’t always the answer. Everyone can help improve antibiotic prescribing or use.
  3. Antibiotics do not work on viruses, such as colds and flu, or runny noses, even if the mucus is thick, yellow or green.
  4. Antibiotics are only needed for treating certain infections caused by bacteria. Antibiotics also won’t help some common bacterial infections including most cases of bronchitis, many sinus infections, and some ear infections.
  5. An antibiotic will not make you feel better if you have a virus. Respiratory viruses usually go away in a week or two without treatment. Ask your healthcare professional about the best way to feel better while your body fights off the virus.
  6. Taking antibiotics creates resistant bacteria. Antibiotic resistance occurs when bacteria develop the ability to defeat the drugs designed to kill them.
  7. If you need antibiotics, take them exactly as prescribed. Talk with your doctor if you have any questions about your antibiotics, or if you develop any side effects, especially diarrhea, since that could be a C. difficile (c. diff) infection which needs to be treated right away.

Prescribing antibiotics appropriately will continue to provide treatment opportunities for serious illnesses like sepsis. Sepsis is a life-threatening condition that can lead to tissue damage, organ failure, amputations, and death ( ).

Sepsis Facts:
  • Each year over 1.7 million people contract sepsis – that’s 1 person every 20 seconds.
  • 3rd leading cause of death
  • 87% of cases start in the community and not in the hospital.
  • 42% of Americans have not heard of sepsis.
  • Risk of death from sepsis increases as much as 8% each hour that treatment is delayed.
  • As many as 80% of sepsis deaths could have been prevented with rapid diagnosis and treatment.
  • Cost of hospital treatment of sepsis is $24 billion per year.
Home Health’s Role with Sepsis
Clinicians need to learn about sepsis, including the early signs and symptoms and when to seek emergent care for the patient. Home health professionals have a great opportunity for early detection to save lives. The Sepsis Alliance is an organization dedicated to providing information and resources about sepsis for clinicians, patients, and families. “ TIME ” is a simple acronym for sepsis symptoms that is easy to remember and communicates urgency.
Learn more about sepsis by watching HHQI’s recorded webinar, Recognizing & Caring for Patients with Sepsis
Antibiotic Resistance

C. Diff


This material was prepared by Quality Insights, the Medicare Quality Innovation Network-Quality Improvement Organization supporting the Home Health Quality Improvement National Campaign, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The views presented do not necessarily reflect CMS policy. 
Pub. No. 11SOW-WV-HH-ADL-122118