Re: RE Prophylactic Long term Antibiotic usage in RACF

13/09/2019 at 10:16 am #75807 Quote

Anonymous

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Hi Karen

Thank you for the update. It is frustration when you know that a GP(s) is well aware of guidelines but do not regularly adhere to same or are inconsistent with their prescribing. This is particularly evident when a Resident is presenting as asymptomatic and appear to prescribe just in case not when indicated. Once again thank you for your assistance and update. It is interesting to see what happens outside of a RACF environment.

Kind regards
Karen Panzich
TLRN / IC Coordinator
Wynyard Care Centre

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Karen Panzich
Teamleader RN
Synovum Care Group
Cnr Quiggin and Moore St, Wynyard TAS 7325
P 03 6442 1760
F 03 6442 1765

http://www.synovumcare.com.au
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From: ACIPC Infexion Connexion [mailto:ACIPCLIST@ACIPC.ORG.AU] On Behalf Of karenbooth1@BIGPOND.COM
Sent: Thursday, 12 September 2019 6:05 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] RE Prophylactic Long term Antibiotic usage in RACF

Hi Karen,
Most GPs are well aware of the guidelines. It is a common topic in GP medical weekly magazines but they succumb to habit and pressure from families and RACFs where they routinely test asymptomatic patients and send off urines for MCS. I work in general practice and take calls from RACFs regularly. More work needs to be done to assist RACF in better understanding of AMR and prescribing antibiotics for asymptomatic patients and protocols re testing of same. Some female patients would benefit from topical oestrogen as a preventative but this is not commonly discussed for elderly women. I know ACIPC is running aged care IPC workshops.

The commonwealth Chief Medical Officer writes to GPs and antibiotic prescribing is often a target of his messages.

Kind regards
Karen

Karen Booth
RN BHSCN GAICD
President APNA
Australian Primary Health Care Nurses Association
M: 0411 898 884
karenbooth1@bigpond.com

Australian Primary Health Care Nurses Association (APNA)
Level 17/350 Queen Street, Melbourne VIC 3000
p: 1300 303 184 f: (03) 9322 9599
president@apna.asn.au | http://www.apna.asn.au
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From: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU> On Behalf Of Team Leader RN Wynyard
Sent: Tuesday, 10 September 2019 1:32 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] RE Prophylactic Long term Antibiotic usage in RACF

Hi Trent
Thank you very much for the information
It appears that the GPs in question generally do make reference to the Therapeutic Guidelines and generally prescribe only once and if symptomatic and /or when all other interventions have proved unsuccessful. ( recurrent infections occur 2 or more in 6 months). I struggle to get them to review and consider ceasing once this occurs as they of the opinion that the so called infection will reoccur to the detriment of the Resident involved. It is frustrating especially when they do in part understand the requirement of responsible prescribing and generally do prescribed as per the recommended criteria but to then turn around and refuse to consider ceasing especially after 6 months and sometimes 12 months plus .. I will just have to persist.

Karen Panzich RN / IC Coordinator
Wynyard Care Centre
Tasmania

[cid:image001.jpg@01D567DB.A8B6D1F0]
Karen Panzich
Teamleader RN
Synovum Care Group
Cnr Quiggin and Moore St, Wynyard TAS 7325
P 03 6442 1760
F 03 6442 1765

http://www.synovumcare.com.au
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Any views or opinions presented in this email are solely those of the author and do not necessarily represent those of the company. Employees of Synovum Care Group are expressly required not to make defamatory statements and not to infringe or authorise any infringement of copyright or any other legal right by email communications. Any such communication is contrary to company policy and outside the scope of the employment of the individual concerned. The company will not accept any liability in respect of such communication, and the employee responsible will be personally liable for any damages or other liability arising.

From: ACIPC Infexion Connexion [mailto:ACIPCLIST@ACIPC.ORG.AU] On Behalf Of Trent Yarwood
Sent: Tuesday, 10 September 2019 12:55 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] RE Prophylactic Long term Antibiotic usage in RACF

Hi Karen,

There’s lots more information on the scale of this problem in the Aged Care National Antimicrobial Prescribing Survey (acNAPS) – report available here: https://www.safetyandquality.gov.au/publications-and-resources/resource-library/2017-aged-care-national-antimicrobial-prescribing-survey-report

Therapeutic Guidelines: Antibiotic has a good and pretty clear section on indications for long-term prophylaxis for UTIs – including only if non-antibiotic measures fail, greater than two infections in six months, and for a defined period of time then ceasing (recommended at six months).

This is a huge potential area for quality improvement, and needs more than just a screening urine to solve, but certainly the docs should be collecting urine to make sure the patients don’t have resistance and repeating them if the patient develops new clinical symptoms, but I don’t think routine urines while patients are on therapy are the way to go.

Trent
Qld Statewide AMS Program

—
Trent Yarwood
trentyarwood@gmail.com
PGP Key: 246AF263

On Tue, 10 Sep 2019 at 11:47, Team Leader RN Wynyard <TeamLeaderRNWynyard@synovumcare.com.au> wrote:
Hi all

I just have a question regarding GP s who prescribe Antibiotics prophylactically to minimise recurrent infections. Some have had prophylactic antibiotics prescribed for recurrent UTIs for example ( more than 4-5 in previous 12 month period)
Some of our Residents have been on Prophylactic Antibiotics for > 6 months.
Predominantly for either recurrent UTI or Respiratory Tract infections (exacerbation of COPD)
Around 50 % (sometimes higher depending on others prescribed) of our Monthly data statistic in regards to Antibiotics prescribed consists of those who are on ongoing prophylactic antibiotics

Should these Residents have a specimen sent to pathology for M S & C at any time to confirm whether they have become Resistant during the 6 months plus they have been prescribed them ?
Should a GP at minimum be reviewing this in regards to ceasing at any specified time ?

Kind Regards
Karen Panzich TLRN / Infection Control Coordinator
Wynyard Care Centre
Tasmania

Karen Panzich
Teamleader RN
Synovum Care Group
Cnr Quiggin and Moore St, Wynyard TAS 7325
P 03 6442 1760
F 03 6442 1765

http://www.synovumcare.com.au
Any views or opinions presented in this email are solely those of the author and do not necessarily represent those of the company. Employees of Synovum Care Group are expressly required not to make defamatory statements and not to infringe or authorise any infringement of copyright or any other legal right by email communications. Any such communication is contrary to company policy and outside the scope of the employment of the individual concerned. The company will not accept any liability in respect of such communication, and the employee responsible will be personally liable for any damages or other liability arising.

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