Prescribing in a Long Term Care Facility / Nursing Homes

Successive HALT- Halting infections in long-term care studies have shown that Irish Nursing home residents are prescribed far more antibiotics than their European counterparts . Antibiotics are most commonly prescribed for UTI , RTI and skin and soft tissue infections . 39% of antibiotics are prescribed for prophylaxis mainly recurrent UTI which is rarely justified .

http://www.hpsc.ie/a-z/microbiologyantimicrobialresistance/infectioncontrolandhai/surveillance/hcaiinlongtermcarefacilities/

Superbugs including CPE

In October 2017, the Minister for Health declared a public health emergency in relation to CPE This GP CPE toolkit contains a number of documents including guidelines for general practice, guidance for healthcare staff visiting patients at home, a set of facts sheets on CPE and patient information..

https://www.hse.ie/eng/about/who/healthwellbeing/our-priority-programmes/hcai/resources/gp-cpe-toolkit/

We  are developing more specific target guidance on nursing homes including dipstick and MSU polices for local adaptation but in the interim there is lots of useful relevant guidance already on our website

UTI

50 % of frail elderly residents have asymptomatic bacteriuria – be mindful of treating symptomatic patients not MSU reports. Do not dipstick or send MSU unless patient is symptomatic. Some useful guidance on interpreting MSU results in nursing home patients with or without a catheter here

https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/conditions-and-treatments/urinary/uti-care-residents-65-years/urinary-tract-infection-uti-in-long-term-care.html

RTI

Acute exacerbation COPD

https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/conditions-and-treatments/lower-respiratory/acute-exacerbation-of-copd/acute-exacerbation-of-copd.html

Community acquired pneumonia

https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/conditions-and-treatments/lower-respiratory/community-acquired-pneumonia/community-acquired-pneumonia.html

Cellulitis

https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/conditions-and-treatments/skin-soft-tissue/cellulitis/

Recurrent cellulitis and leg ulcers

https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/conditions-and-treatments/skin-soft-tissue/recurrent-cellulitis-and-leg-ulcers/leg-ulcers.html

Shingles

https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/conditions-and-treatments/skin-soft-tissue/varicella-zoster/

Drug interactions

Patients in nursing homes or other long-term care facilities may be particularly frail or have other co-morbidities (such as heart failure or chronic renal failure) and be on several medications. These factors may influence the effects and side-effects and drug interactions of any antibiotics prescribed. Some useful guidance on important antibiotic/other drug interactions here:

https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/drug-interactions/

Influenza

Specific Guidance on managing Influenza  in nursing homes or long term care facilities is linked at the end of our influenza section  

https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/conditions-and-treatments/influenza/seasonal-influenza.html

Clostridium difficile

https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/conditions-and-treatments/gastro/clostridium-difficile/clostridium-difficile.html

Reviewed March 2018