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New research identifies opportunities for community pharmacy to support antimicrobial stewardship in care homes

30 January 2019

50% of care home residents are prescribed at least one antibiotic over a 12 month period

New UK-wide research, led by Boots UK, highlights potential areas where community pharmacists and their teams can support both residents and carers in care homes in the appropriate and effective use of antibiotics.

Antimicrobial resistance (AMR) is a major global public health problem which could prevent the treatment of common bacterial infections[1] and in 2016, the UK government set a target to reduce inappropriate prescribing of antibiotics by 50%, with the aim of being a world leader in reducing prescribing by 2020.[2]

Inappropriate use of antibiotics includes prescribing an antibiotic in the absence of evidence or clear rationale of a bacterial infection, and continuation of course beyond recommended guidelines.[3] Previous research published by PHE shows the level of inappropriate prescribing in primary care in England as 20%[4], suggesting that levels of prescribing should be reduced by 10% to meet the Government target.

The research published today in JAC, looked at the levels of antibiotic use across care homes in the UK, including multiple courses and variability in duration of treatment. Half of care home residents were prescribed at least one antibiotic over a 12 month period, suggesting there is an opportunity to optimise antibiotic use in this vulnerable population to minimise the risk of antimicrobial resistance and treatment failure.

There are 459,000 residential places in care homes across England,[5] 16,000 across Northern Ireland,[6]  41,000 across Scotland,[7]  and 26,000 across Wales.[8] The majority are elderly and have complex healthcare needs that are exacerbated by multiple co-morbidities and medicines related issues from polypharmacy.[9]

Community pharmacy teams dispense acute prescriptions for antibiotics for residents, and can identify potential interactions with current medications, and identify any known allergies. Researchers believe that following the recent focus of increasing the clinical role of pharmacists within care homes, this is an opportunity to consider actions to support prudent antibiotic prescribing and improved antimicrobial stewardship across the UK.

This includes self-care (through homely remedy policies), helping carers to identify and deal with early signs of deterioration and, when antibiotics are prescribed, whether they are appropriate along with advice to support them being used effectively. There is also an opportunity for community pharmacy teams to work more closely with carers within care homes, including infection prevention measures such as flu vaccinations and encouraging adequate hydration to prevent UTIs, which are more common in these vulnerable adults.

Marc Donovan, Chief Pharmacist at Boots UK, comments: “While nurses and carers provide the majority of long term care for older people within care homes, pharmacists across the UK support residents within these settings by dispensing and supplying medicines, as well as providing advice and support to carers on medicines use, storage and waste.

“As pharmacists, we’re all working to promote integration across healthcare disciplines and sectors to promote more efficient and effective care within the NHS. The NHS Long Term Plan, released earlier this month, recognises that many people living in care homes are not having their needs assessed and addressed as well as they could be.

“This research highlights that there is a real opportunity for community pharmacy to play an even greater role in supporting the safe and effective use of medicines, and continue to support the implementation and delivery of the government’s five-year action plan on Antimicrobial Resistance.”

The research paper, titled ‘Antibiotic prescribing for residents in long term care facilities across the United Kingdom’, was co-authored by researchers at Boots UK, Public Health England and NHS Improvement.

It has been published in the Journal of Antimicrobial Chemotherapy (JAC). The full paper can be found here: https://academic.oup.com/jac/advance-article/doi/10.1093/jac/dkz008/5304212.

 

[1] Public Health England. UK Five Year Antimicrobial Resistance Strategy 2013 to 2018. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/244058/20130902_UK_5_year_AMR_strategy.pdf

[2] HM Government.  Government response to the Review on Antimicrobial Resistance, 2016.

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/553471/Gov_response_AMR_Review.pdf

[3] Advisory Committee on Antimicrobial Prescribing. Resistance and Healthcare Associated Infection (APRHAI), 8th Annual Report, April 2016 - March 2017.

[4] Davies S. Reducing inappropriate prescribing of antibiotics in English primary care: evidence and outlook. J Antimicrob Chemother2018; 73:833-4.

[5] Care Quality Commission.  The state of health care and adult social care in England 2017/18. https://www.cqc.org.uk/publications/major-report/state-care

[6] Regulation and Quality Improvement Authority, Northern Ireland.  https://www.rqia.org.uk/RQIA/files/d9/d9ede6b4-90d5-4465-b7be-5ba4ad4f39ba.pdf

[7] UK Statistics Authority. Care home census for adults in Scotland. Figures for 2007-2017. http://www.isdscotland.org/Health-Topics/Health-and-Social-Community-Care/Publications/2018-09-11/2018-09-11-CHCensus-Report.pdf

[8] Welsh Government. https://statswales.gov.wales/Catalogue/Health-and-Social-Care/Services-for-Social-Care-and-Childrens-Day-Care/cssiwservicesandplaces-by-setting-year

[9] Falconer M, O’Neill D. Profiling disability within nursing homes: a census based approach. Age Ageing 2007; 36(2):209–13.