Call for aged care to participate in annual antimicrobial survey

A recent review of the medication charts of 12,344 residents across almost 300 aged care homes has shown significant use of antimicrobials for residents without infection being present.

A recent review of the medication charts of 12,344 permanent, respite and transitional care residents in almost 300 Australian aged care homes has shown significant use of antimicrobials for residents without infection being present.

Antimicrobial resistance is widely recognised to be a global threat to human health, with the World Health Organisation listing it as a priority issue of our time, according to Australia’s National Centre for Antimicrobial Stewardship (NCAS).

Since 2015, NCAS conducts an annual aged care National Antimicrobial Prescribing Survey (acNAPS) in Australian residential care facilities to help improve their antimicrobial use.

The 2017 survey showed that the proportion of residents who were prescribed at least one antimicrobial was 8.9 per cent while the proportion of residents who had signs or symptoms of infection was only 2.9 per cent.

Dr Noleen Bennett

The survey also found prolonged duration of prescriptions, widespread use of topical antimicrobials and incomplete documentation

These findings clearly show that antimicrobial use can be improved in aged care, said acNAPS project officer Dr Noleen Bennett, who spoke to AAA.

“Harm from inappropriate antimicrobial use is potentially significant for frail and older residents living in aged care homes,” she said.

Antimicrobial snapshot

  • Cephalexin was the most commonly prescribed antimicrobial (20 per cent).
  • The three most common infections for prescribing antimicrobials were skin or soft tissue (31 per cent), urinary tract (27 per cent) and respiratory tract (21 percent).
  • One-third of antimicrobials were prescribed for residents who had no signs or symptoms of infection in the week prior to the antimicrobial start-date.
  • 6 per cent of suspected infections did not meet the internationally recognised infection definitions that have been specifically developed for use in aged care homes.
  • 22 per cent of antimicrobials had been administered for longer than six months.
  • Topical antimicrobials accounted for over 29.5 per cent of prescriptions.
  • The indication for the antimicrobial was not documented for 22 per cent of antimicrobials administered, and the review- or stop-date was not documented for 49 per cent of antimicrobials administered.

Dr Bennett said the facilities that participated in acNAPS were focused on high-quality care and were now implementing activities to improve antimicrobial use.

“In the facilities that have successfully improved antimicrobial use, all staff were involved – general practitioners, nurses, pharmacists and administrators.

“All Australian aged care homes are strongly encouraged to participate at least annually in acNAPS,” she said.

The results of the 2017 acNAPS survey, conducted between 19 June and 1 September 2017, have now been communicated to all 293 participating facilities to assist their quality improvement initiatives.

On completing their data entry, each facility can generate customised reports and examine their local issues.

They can undertake the acNAPS any time during the year for local use; however, only data collected during the official survey period is included in the public reports.

“Improving the safety and quality of care in the aged care sector is a national priority and it is recommended that all Australian aged care homes participate in the acNAPS in 2018 and use it as a quality improvement tool,” Dr Bennett said.

acNAPS is a collaborative project supported by the Australian Commission on Safety and Quality in Health Care under the Antimicrobial Use and Resistance in Australia project.

Further information is available on the NAPS website.

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Tags: antimicrobial guidelines, antimicrobial resistance, National Centre for Antimicrobial Stewardship, noleen-bennett,

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