Doctors are commonly making decisions over the phone to prescribe antibiotics to the elderly at aged care facilities, according to research published in the Medical Journal of Australia.
Dr David Kong and colleagues from the Monash University Centre for Medicine Use and Safety conducted one-on-one interviews and focus groups with 61 doctors, nurses and pharmacists servicing 12 Victorian residential aged care facilities (RACFs).
“Widespread and inappropriate antibiotic use in RACFs … is especially concerning given emerging evidence of antibiotic resistance in RACFs,” the researchers write.
Rapid staff turnover, lack of experienced nurses and variability of assessment quality were cited as problems with nurse-led antibiotic prescribing.
“Several GPs also raised concerns about over reporting of symptoms and some perceived pressure from nurses to treat residents with antibiotics for minor complaints, leading to unnecessary antibiotic prescribing”, the authors wrote.
All participants in the survey agreed that the lack of onsite doctors at aged acre faciities was an important concern, with antibiotics most commonly prescribed over the phone.
And most visiting GPs tend to prescribe antibiotics early rather than “waiting and observing”. Routine use of locum services, particularly after hours and on weekends, was also considered a factor in the greater use of antibiotics.
The Australian Therapeutic guidelines on antibiotic were rarely followed, the researchers reported.
Most GPs and nurses interviewed felt that early initiation and the use of broader spectrum antibiotics was warranted because of the frailty of the aged residents.
The researchers say this perception could be driving inappropriate antibiotic overuse.
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