目的:探索澳大利亚老年护理机构(RACF)的抗菌管理流程,包括抗菌药物处方,供应,administration,以及为监视活动提供信息的文件。
方法:自愿,在线横断面调查。
方法:该调查已传播到所有寻求感染预防和控制领导(首选受访者)参与的南澳大利亚RACF(n=237),护士或高级RACF工作人员,或者老年护理药剂师。
方法:调查于2023年5月至6月开放。旨在了解临床和药物管理系统的问题,抗菌药物处方和供应的来源,外部医疗保健提供者的管理和抗菌药物管理的文件。开发了RACF中抗菌管理的过程图。
结果:在分析中包含的54个RACF(29.5%的响应率)中,大多数人使用电子临床文件系统(74.1%)或混合电子纸质系统(22.2%)。药物图表要么是电子的(81.0%),混合动力(5.6%),或纸质(13.0%)。抗菌药物是由住院医师的普通全科医生开的,但也是由机车,医院或专科医生,执业护士,虚拟护理医生,和牙医。Oral,topic,吸入性抗菌制剂通常由社区药房提供,静脉制剂主要由医院提供,由外展护士管理。几乎所有RACF(96.2%)都具有包括口服和静脉内制剂在内的抗菌药物储备。抗菌药物主要由注册护士或注册护士管理。
结论:RACF中的抗菌药物管理是复杂的,特别是在护理过渡期间。多个处方和抗菌药物的来源,使用不同的临床文档系统,特别是外部医疗保健提供者,与定额备用金供应有关的临床治理被确定为可以改善药物管理的关键领域。解决这些差距将有助于全面,澳大利亚RACF的实时抗菌监测。
OBJECTIVE: To explore antimicrobial management processes in Australian residential aged care facilities (RACFs), including antimicrobial prescribing, supply, administration, and documentation to inform surveillance activities.
METHODS: Voluntary, online cross-sectional survey.
METHODS: The survey was disseminated to all South Australian RACFs (n = 237) seeking participation from an infection prevention and control lead (preferred respondent), a nurse or senior RACF staff member, or an aged care pharmacist.
METHODS: The survey was open during May-June 2023. Questions aimed to understand clinical and medication management systems, sources of antimicrobial prescription and supply, management by external health care providers and documentation of antimicrobial administration. A process map of antimicrobial management in RACFs was developed.
RESULTS: Of the 54 RACFs included in the analysis (29.5% response rate), most used an electronic clinical documentation system (74.1%) or a hybrid electronic paper-based system (22.2%). Medication charts were either electronic (81.0%), hybrid (5.6%), or paper-based (13.0%). Antimicrobials were prescribed by the resident\'s usual general practitioner, but also by locums, hospital or specialist physicians, nurse practitioners, virtual care physicians, and dentists. Oral, topical, and inhaled antimicrobial formulations were usually supplied by community pharmacies, and intravenous formulations were predominately supplied by hospitals for administration by outreach nurses. Almost all RACFs (96.2%) had imprest stock of antimicrobials that included both oral and intravenous formulations. Antimicrobials were predominately administered by an enrolled nurse or a registered nurse.
CONCLUSIONS: Antimicrobial management in RACFs is complex, particularly during care transitions. Multiple prescribers and sources of antimicrobials, use of different systems for clinical documentation, particularly by external health care providers, and clinical governance relating to imprest supplies were identified as key areas where medication management could be improved. Addressing these gaps will facilitate comprehensive, real-time antimicrobial surveillance in Australian RACFs.