The Aged Care National Antimicrobial Prescribing Survey (AC NAPS) is an annual survey of infections and antimicrobial prescribing practices in Australian aged-care homes and multipurpose services.7 Its primary aim is to assist participating facilities to reduce infections and improve their use of antimicrobials.
AC NAPS is a point prevalence survey. De-identified data are collected from residents’ medical records and entered into an online AC NAPS database by participating nurses, pharmacists or infection-control nurse consultants. The first survey was piloted nationally in 2015,8 and was followed by surveys in 2016,9 201710 and 201811. The survey has consistently highlighted aspects of antimicrobial use in aged-care facilities that could be improved.
In 2018, the medication charts of 20,030 permanent, respite or transitional aged-care residents from 407 facilities were reviewed. Facilities from every state and territory in Australia participated. Victorian, state-government-operated, and major city and inner-regional facilities contributed proportionally more data to the survey than their actual representation in the Australian aged-care sector.
Significant results of the survey
On the day of the survey, the following results were found:
- Almost 10% (1988/20,030) of residents were prescribed at least one antimicrobial while only 2.9% (581/20,030) had signs or symptoms of infection.
- Nearly 65% (64.6%, 1009/1563) of recently prescribed antimicrobials were for residents who did not have documented signs or symptoms of suspected infection in the week before they started treatment.
- Over a quarter (28.3%, 663/2341) of antimicrobials had been administered for longer than six months.
- Topical antimicrobials made up over one-third (36.3%, 849/2341) of antimicrobials prescribed.
- Incomplete documentation was a prominent barrier to proper review of medicines. The indication for the antimicrobial was not documented in a quarter of prescriptions (25.1%, 587/2341), and the review date or stop date was not documented for 58.9% (1380/2341) of prescriptions.
- Other – skin, soft tissue or mucosal (18.3%, 428/2341), cystitis (16%, 375/2341) and pneumonia (9.4%, 221/2341) were the three most common indications presumed or documented for antimicrobials prescribed.
- Cefalexin (20.3%, 475/2341) was the most commonly prescribed antimicrobial, followed by clotrimazole (19%, 444/2341).
These findings show there is scope for improvement. The discrepancy between the proportion of residents who were prescribed antimicrobials and the proportion who were identified as having signs or symptoms of infection presents a potential target for quality improvement. In the latter group, the proportion of residents whose suspected infections met infection criteria was only 22.1% (346/1563).
The observed widespread practice of prolonged antimicrobial use (including for prophylaxis) was surprising and suggests that more frequent review and re-evaluation of antimicrobial therapy is required. The findings of the survey may relate to wider system issues such as fragmented access to visiting medical staff and lack of continuity of care.12
The findings also point to priority infections in this setting and the antimicrobials that are being used for treatment. The results could be used to help guide clinical education on these specific conditions.