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Hello everyone,
In follow up from a sensation presentaion by Prof Lisa Hall on AMS, please find below the responses to questions unanswered during the webinar.
1. How can we approach GPs with regards to AMS?
Attendee response – I have a great working relationship with our GP & NP and pharmacist. Residents only get put on antibiotics as a last resort!! education guidelines need to be enforced down the line.
Attendee response – I organize my pharmacist to send me monthly data reports on AMS and polypharmacy – RACF to share with GPS
Attendee response – I managed to ban nurse-initiated dipstick testing across all my RACHs. Dipsticks can now only be used if specifically requested by a GP or NP. If one is requested, I have trained the nurses to ask the prescriber to document the clinical rationale.
Lisa: These are all great suggestions. Key thing is to explore how you can best work together by understanding where the opportunities are for medication reviews, and feedback on prescribing patterns. Using audit and feedback tools like NAPS and working with your pharmacist can be helpful.
2. In the core elements in the US program, what sort of accountability elements did you find?
Lisa: We found most nursing homes (as they are known there) had a stewardship program and governance structure in place with the program reporting through to a safety and quality committee or similar. They also had prescribing and infection management guidelines available. About half of the IPs reported they participated in regular rounds where they reviewed appropriateness of prescribing. Overall home health had a much lower level of AMS in place.
3. Lisa, the issue we have found with NAPS audits – the quality of the data captured. From all aspects – the data entered from the GP / documentation from the staff and administration, the auditor changing every year as we turn over IPC aged care leads and the essential tick box aspect of this data. Very exciting to hear this will change.
Lisa: Thanks – we are excited to be working on improvements to Aged Care NAPS! We will be continuing to work on new e-learning resources as well as the revised algorithm and appropriateness auditing in the next year which should improve the quality and usefulness of the system as a whole.
4. What can we do if our facility is not registered on NAPS?
National Antimicrobial Prescribing Survey (NAPS): https://naps.org.au/. For any registering issues please use the Contact Us link: https://naps.org.au/ContactUsExt.aspx/
5. Can these slides be shared with the attendees please
Recordings and slide presentations are always provided on the ACIPC Aged Care Space webinar page: https://www.acipc.org.au/acipc-aged-ipc-webinar-series/
Sept: https://www.acipc.org.au/acipc-aged-ipc-webinar-series/actioning-ams/
6. Could you please provide the AMS checklist? Is there an appropriate AMS monitoring tool to benchmark usage in RACHs?
Aged Care Quality and Safety Commission AMS Resources: https://www.agedcarequality.gov.au/providers/clinical-governance/antimicrobial-stewardship/antimicrobial-stewardship-resources
See the Self-assessment tools for the checklists.If you were not able to see the webinar – please simply go onto the ACIPC Aged Care space and you can see the recording and a copy of the slides – https://www.acipc.org.au/acipc-aged-ipc-webinar-series/actioning-ams/
Regards Carrie
Hello Everyone,
The Aged Care Quality and Safety Commission has also kindly respoded to questions from the COP webinar:
ACQSC Response
1. Where some prescribers continue to prescribe PRN topical antimicrobials without clear clinical indications, defined duration, or review requirements, what mechanisms does the Commission have to reinforce adherence to antimicrobial stewardship principles?
The Aged Care Quality and Safety Commission regulate aged care providers. We do not regulate prescribers or provide comment on a prescriber’s trends. We regulate against the Aged Care Act 2024 and the Aged Care Quality Standards. Aged Care providers should have an effective antimicrobial stewardship (AMS) system that reflects contemporary, evidence-based practice and is relevant to the service context. AMS systems help services promote appropriate use of antimicrobials, improve care for older people, and reduce the negative effects of using antimicrobials (including antimicrobial resistance, toxicity and unnecessary costs).The Commission has developed a range of resources to help providers implement and strengthen their AMS practices, including:
The AMS Self-Assessment Tool and User Guide supports providers to monitor and understand their progress towards creating a comprehensive AMS program. Chapter 16 of the Antimicrobial Stewardship Book – Antimicrobial stewardship in community and residential aged care and the Antimicrobial Stewardship Clinical Care Standard have recommendations of contemporary, evidence-based practice.
The AMS and quality improvement for aged care leaders program helps providers to develop, implement and improve their AMS systems
To Dip or Not to Dip (TDONTD) is a quality improvement activity to improve the way providers assess and manage urinary tract infections (UTIs). It aims to reduce inappropriate antibiotic prescribing for UTIs in aged care. To Dip or Not to Dip resources include an audit tool.2. Given that aged care providers are responsible for supporting safe medication management but do not independently control prescribing decisions, how does the regulatory framework ensure that prescribing accountability is appropriately shared with, and enforced for, prescribers?
Aged care providers have an important role in maintaining an effective antimicrobial stewardship (AMS) system. The Aged Care Quality and Safety Commission does not regulate prescribers, and prescribing decisions are the responsibility of the medical or nurse practitioner. However, providers must promote and support best-practice antimicrobial use within their service. This includes providers having processes in place to effectively engage with prescribers and provide relevant information, assessments, and support to inform clinical decision-making and appropriately document.3. How does the Commission monitor and respond to repeated non-compliance with antimicrobial prescribing guidelines, particularly where inappropriate prescribing may contribute to antimicrobial resistance (AMR)?
The Aged Care Quality and Safety Commission monitor providers and workers to make sure they comply with their aged care obligations under the Aged Care Act and the Aged Care Rules.
