There is widespread antibiotic prescribing in aged care homes and limited evidence to guide antimicrobial stewardship. However, good antimicrobial stewardship programs in hospital settings can be adapted for aged care homes.
There are many reasons why antibiotics are over-prescribed in aged care homes. These include:
- inexperienced staff
- lack of training of nurses in antibiotic use
- lack of onsite medical and pharmacy staff
- lack of institutional infection management guidelines.
Data is collected and published through the Aged Care National Antimicrobial Prescribing Survey (acNAPS). The data shows that better prescribing practices are needed in aged care homes to limit antibiotic use.
Some resources to help properly prescribe antibiotics are listed below.
Therapeutic Guidelines: Antibiotic
Access to, and use of, antibiotic prescribing guidelines should be standard practice in all health care settings where antibiotics are prescribed.
The Therapeutic Guidelines: Antibiotic was produced by the Antibiotic Expert Group of Therapeutic Guidelines Limited. The guidelines represent the best available evidence and opinion regarding antibiotic treatment in Australia. The guidelines advise prescribers on antibiotic treatment, including:
- choosing the best antibiotic
- correct dose
- how it should be taken
- when to commence the treatment.
Australian Medicines Handbook
The Australian Medicines Handbook is an important clinical resource for health professionals about the proper use of medicines. It provides guidance on prescribing antibiotics including contraindications, precautions, side effects and dose adjustments for specific populations.
Aged care residents use a large number of medications due to the higher presence of disease and the multiple illnesses older people experience. The Medical care of older persons in residential aged care facilities (Silver Book) has advice on managing complex medication needs for residents.
The Silver Book aims to provide general practitioners and other health professionals, including nurses, on how to provide infection care in aged care homes
It includes chapters on how to properly manage respiratory and urinary tract infections. It also has guidance on how to put in place infection prevention and control measures specific to aged care homes.
Core elements of antibiotic stewardship for Nursing Homes
The United States Centers for Disease Control and Prevention has developed the Core Elements of Antibiotic Stewardship for Nursing Homes. It explains how to adapt hospital antibiotic stewardship practices for aged care homes.
Aged care homes are encouraged to work in a step-wise fashion, implementing one or two activities to start. They can gradually add new strategies.
Taking acting to improve the use of antibiotics should help to:
- reduce adverse events
- prevent emergence of resistance
- lead to better outcomes for residents.
- Antibiotic use in residential aged care facilities, Lim C, Stuart R, Kong D, Australian Family Physician, Vol.44, No.4, April 2015.
- National Centre for Antimicrobial Stewardship, aged care home stream.
The following resources may help you to talk to patients about antibiotic resistance and when antibiotics are needed:
What you can do: This fact sheet explains the actions everyone can take to reduce antibiotic resistance.
The Respiratory Tract Infection Action Plan: This resource was developed by NPS MedicineWise. It provides options to help patient with acute respiratory infections who are not prescribed antibiotics.
Childhood RTI Fact Sheet: What every parent should know: This fact sheet was developed by NPS MedicineWise. It may help you to reassure parents about the expected duration of symptoms and how to identify signs of more serious illness. This may help managing their expectation for antibiotics.
Choosing Wisely Australia provides information for patients and carers about antibiotics and antibiotic resistance.
NPS MedicineWise provides important guidance on the correct use of antibiotics.