Antibiotics 'at risk' of being overused in aged care settings

23 July, 2014

Antibiotics are being overused in residential aged care facilities (RACFs), and more integrated efforts to improve antibiotic prescribing practices need to be introduced, researchers say.

Important workflow and culture-related issues could contribute to overuse of antibiotics in these facilities, a recent report published in the Medical Journal of Australia by Monash University (MU) researchers found.

Special attention and guidelines beyond those used in acute-care settings should be instituted, the report recommended.

It's a recommendation agreed upon by Gerald Quigley, accredited pharmacist and herbalist, medical consultant for BioRevive, a specialist supplier of pharmaceutical products.

Quigley said that the use of antibiotics should be done by exercising prudent judgement.

"Antibiotics need to be used judiciously, bearing in mind the increased risk of antibiotic resistance in the aged-care setting," Quigley said.
"The World Health Organization has recently announced that antibiotic resistance presents the greatest threat to world health."

Lack of institutional policy, early prescription

The Monash University study found a number of workflow-related issues in antibiotic prescribing in RACFs, such as a lack of onsite medical doctors and pharmacy supports, nurse-led antibiotic prescribing, and no institutional policy for antibiotic use.

The critical monitoring and reviewing of patients has been a crucial step missing in the process, according to Dr David Kong, a researcher at MU's Centre for Medicine Use and Safety,

"We found that antibiotics were commonly prescribed over the phone, which wasn't always followed up with an on-site review, and most visiting GPs tended to prescribe antibiotics early rather than 'waiting and observing'," Dr Kong said.

Nurse-driven infection management, next-of-kin expectations

Dr Kong said: "We also found there were mixed opinions on nurse-driven infection management, ranging from GPs with confidence in the nursing assessment to perceiving pressure from nurses to prescribe antibiotics.

"Nurses themselves reporting lack of knowledge on antibiotic prescribing and quite a number of nurses felt their responsibility in infection management overwhelming.

"Decisions for antibiotic prescribing are often difficult considering the frailty of elderly patients and many of those with behavioural problems or cognitive deficits.

"Further, there were often unrealistic expectations from family members to prescribe antibiotics for minor symptoms or to avert hospitalisation."

Dr Kong said the findings reflected the need for initiatives to optimise antibiotic use in residential aged care facilities, and the next phase was to look at how to collectively improve antibiotic use.

"This could include further education and training, and introduction of evidence-based guidelines specific to the RACF setting."