Aged care antimicrobials up

The PSA has taken aim at antimicrobial prescribing in aged care, warning of a significant increase

Data released this week show prescription rates for antimicrobials in aged care facilities are on the rise and residents and care staff receive limited support to ensure that these medicines are being used effectively, says the Pharmaceutical Society of Australia.

The 2018 Aged Care National Antimicrobial Prescribing Survey (NAPS) found nearly 10% of aged care residents were prescribed antimicrobials – compared to 8.8% in 2017.

“In just one year we have seen a significant and concerning increase in antimicrobial prescribing,” PSA National President A/Prof Chris Freeman warned.

“The World Health Organisation has named antimicrobial resistance as a global health threat. Antimicrobial resistance means our most powerful medicines, such as antibiotics, may no longer be effective in treating infections like pneumonia.

“Over prescription of antimicrobials and misuse of these lifesaving medicines are factors in the rise of resistance.”

According to the latest NAPS, antimicrobial review or stop dates are not documented for 58.9% of prescriptions; the documentation of indication was missing for 25.1% of prescriptions; and almost one-fifth of antimicrobials were prescribed for as needed administration.

“This means residents may be taking antimicrobials longer than necessary, or worse when they don’t even need to,” A/Prof Freeman said.

“There is no clear finish date or prompt for a health care provider to check in with an aged care resident, or the care staff to make sure they are still taking or have ceased taking an antimicrobial based on their current health.

“This lack of support to aged care residents, and to facility staff is putting aged care residents and the wider community at risk from the epidemic of antibiotic resistance.

“Pharmacists are experts in medicine, with a primary responsibility at all times to see that medicines are used safely, effectively and judiciously.

“PSA would like to see the expertise of pharmacists more broadly recognised and utilised. This is again, another example of inappropriate medicine use within aged care, often caused by the prescriber making the wrong decisions about medicines.

The report “highlights the real necessity for pharmacists to have more time in aged care facilities and other health care teams to ensure doctors do the right thing with prescribing medicines so that we can improve the safe use of medicines within aged care,” he said.

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  1. Penny Kraemer

    This is very concerning. I’ve created an industry first AMS for Aged Care package for aged care homes to assist in reducing inappropriate antibiotic prescribing and, when antibiotics ARE indicated, to assist in ensuring they are prescribed in accordance with national guidelines. The GPs loved the tailored aged care resource and gave me great feedback so I’ve also created an app version for prescribers (AMS for Aged Care)
    My monthly AMS monitoring for my 1200 aged care beds is consistently reporting >75% orders are not in accordance with guidelines.

    AMS in aged care is a new frontier with it only being introduced as a quality standard in July ‘19. This is a global issue that affects all of us. AMS tools and resources for aged care like the ones I have developed should be mandatory, and, as in the hospitals, there needs to be provision for pharmacist involvement when a different antibiotic or different dosing regimen is indicated.

    • Karalyn Huxhagen

      I have a long list of medications to apply stewardship to since the 1.7.19. My QUM payments do not cover the amount of work involved in performing these roles. The identification of the issue is the tip of the problem. The harder and long haul part is changing practice and influencing prescribers

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