Antibiotic overuse in residential aged care prompts organisational overhaul

The overuse of antibiotics in residential aged care has necessitated the urgent review of organisational workflow and workplace culture in the Australian aged care setting, recent research shows.

The research, published in the Medical Journal of Australia in July, was based around several interviews, focus groups and onsite observations of 61 doctors, nurses and pharmacists servicing 12 residential facilities in Victoria between January and July last year.

Monash University Centre for Medicine Use and Safety in Melbourne researcher Dr David Kong said the overuse of antibiotics in aged care has become a global issue.

“If antibiotics are inappropriately prescribed, it may increase the risk of antibiotic resistance developing,” Dr Kong said.

Aged care residents are particularly susceptible to the adverse effects of antibiotic overuse, he intimated.

“If an individual who remains in aged care acquires bacteria that are resistant to antibiotics, they can pass the bacteria to other people around them.”

Dr Kong said an older person’s frailty can make them more sensitive to sickness. In a residential aged care setting where there are many older people in one location, it is easier for bacteria to be passed on from one person to another.

The research suggested that nurse-driven infection management needs to be more closely monitored.

Even some nurses reported a lack of knowledge on antibiotic prescribing and found their responsibilities in infection management “overwhelming.”

Dr Kong said if nurses are going to be involved in the prescribing of antibiotics, we need to make sure the appropriate training and support is made available to them.

“It’s not about not using antibiotics,” Dr Kong said.

“It’s about using antibiotics if and when we need it.”

A shortage of new types of antibiotics dictates that we must preserve the antibiotics which we currently have, Dr Kong warned.

“If we continue to use them inappropriately, this will lead to an increased risk of bacteria becoming resistant to the existing antibiotics,” he said

“We will end up with a situation where we will no longer be able to use existing antibiotics to treat bacterial infection, because it won’t respond to treatment.”

Dr Kong said prescribers need the right information at the right time to make the appropriate decision regarding infection management of aged care residents.

This requires teamwork from everyone involved; the prescribers, healthcare professionals and the patient themselves, to correctly follow the instructions of their medical practitioner.

“To minimise the risk of antibiotic resistance we need to use them only when we really need them.

“This is everybody’s responsibility.”