Study probes overuse of antibiotics in aged care

Pressure from families and nursing staff to prescribe antibiotics is fuelling their inappropriate use in aged care, the authors of a new study claim.

The qualitative research, which surveyed the views of 61 GPs, nurses and pharmacists working in aged care, explored the workforce and cultural issues influencing antibiotic prescribing.

The study published in the Medical Journal of Australia reported that pressure to prescribe antibiotics from nursing staff and family was significant, and was driven in part by the facility’s fear of litigation.

Antibiotic treatment was also sometimes prescribed for residents in end-stage illness to fulfil family expectation, the study said.

The researchers from Monash University said the unnecessary use of antibiotics was especially concerning given the emerging evidence of antibiotic resistance in aged care facilities.

The lack of on-site doctors and limited pharmacy support was also reported as a major concern.

The study said it was common for antibiotics to be prescribed by phone order, but would not necessarily be followed up by an onsite review.

A reliance on locum doctors especially after hours was also associated with a greater use of antibiotics.

One nurse unit manager told the researchers: “GPs will prescribe something because if they don’t prescribe something it could be three or four days before that resident gets an antibiotic prescribed.”

Only one of the 12 facilities in the study had monitored long-term trends in antibiotic use.

Several facilities also performed regular dipstick urinalysis for all residents, regardless of the presence of symptoms. This was routine practice in facilities, despite studies showing that urine dipstick tests were unreliable for identifying older residents with UTI.

Dr David Kong from the Centre for Medicine Use and Safety at Monash University said most visting GPs tended to prescribe antibiotics early rather than “waiting and observing”.

He said limited access to doctors also put heavy pressure on aged care nurses who reported a lack of training and support in this area. A number of nurses in the study described their responsibility in infection management as overwhelming.

The potential for consultant pharmacists to provide additional support to nursing staff through education and surveillance of antibiotic use was raised by the study.

While rare in Australia, the researchers said extensive antibiotic surveillance was common in the US and in European aged care facilities.

“Monitoring of longitudinal trends of antibiotic use and benchmarking across RACFs will be a useful starting point to improve antibiotic use,” the authors wrote.

The study is believed to be the first to explore the views of health staff on optimising antibiotic prescribing in aged care.