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Table 2 Perceptions of current antibiotic prescribing behaviour and antibiotic resistance in the residential aged care facility setting

From: Antimicrobial stewardship in residential aged care facilities: need and readiness assessment

Themes Positive views Negative views
Perceptions of current antibiotic prescribing behaviour Q1. “It [Antibiotic use] is probably about right, I’ve sort of never had an issue where I’ve thought ‘oh no they should have been on antibiotics or yeah they should not be’, and as I said a lot of our [residents], you’ve got to weigh up the [change of] behaviours and the risks to everyone.” (NUM 13, 30 yr) Q4. “I guess the other thing is that we know particularly in the elderly, it’s better to get in early and treat. So if you think should I/shouldn’t I, then treat, you know, rather than wait until they get crook. And if it’s a bit of over treatment so be it.” (GP 7, 30 yr)
Q2. “It’s usually pretty reasonable. Because bearing in mind that where it may be a viral infection initially, a lot of these people are frail, non-ambulant and will go on to a secondary bacterial infection.” (Consultant pharmacist 5, 12 yr) Q5. “Probably an over use, because we get pressured by nursing staff mostly to prescribe, they're very reluctant to let anyone with a cold be untreated.” (GP 1, 32 yr)
Q3. “We don’t have the luxury of if this antibiotic doesn’t work we’ll try something else, often they [RACF residents] can go down so fast…You don’t have that second chance, so you’ve really got to hit them [with broader spectrum antibiotics].” (GP 13, 30 yr) Q6. “It’s increased for everything; someone sneezes they get antibiotics, somebody’s urine smells or you know it lights up a stick, they get antibiotics.” (NUM14, 12 yr)
Q7. “… some GPs continually use the same antibiotics, you know people are put on the same antibiotics for maybe 2 months….they don’t think to go and check to see if they're resistant or whatever any more.” (NUM 7, 9 yr)
Q8. “Well, there might be an infection, they just go in there and write up a broad-spectrum [antibiotic] and have it for 2 weeks regardless of what the infection is. They're not too much adhering to the [Australian national] antibiotic guidelines.” (Community pharmacist 1, 7 yr)
Perceptions of antibiotic resistance Q9. “I wouldn’t say there's been any change [of antibiotic resistance trend] in all the time I’ve practiced medicine…Probably I don’t do that much pathological testing, but I don’t see it as having been an issue.” (GP 12, 5 yr) Q11. “I would think so, yes, I think you get more of the really unusual urine reports and unusual bacteria or ones with multi resistance, yeah for sure…I guess anywhere where there's a lot of antibiotic use there's going to be a lot of resistance generated.” (GP 1, 32 yr)
Q10. “In the nursing home setting it’s not a major issue…I’d have to look up their [residents’] notes to see [if they have MDR organism infection or colonisation]…It’s not a big issue for us because we are not a hospital setting, so we wouldn’t isolate someone for example who’s VRE [vancomycin-resistant enterococci] positive.” (NUM 1, 13 yr) Q12. “From a wound swab point of view, you're more likely to get a resistant bug in an aged care facility than you are in the community…” (GP 2, 20 yr)
   Q13. “It used to be a really big deal … if someone had MRSA, ‘oh my God’ you know it was the yellow bags and everything came out and we isolated them and we would scrub. Now I mean we wouldn’t even blink if [we see these MDR organisms]. And I don’t think the younger staff realise too the implications of someone having MRSA. But now it's nothing, no one really cares.” (NUM 10, 23 yr)
  1. NOTE. Q = quotes extracted from interview transcripts; NUM = nurse unit managers; GP = general practitioner; yr = years (of work experience in RACF).