Nikki Grae

Health Quality & Safety Commission


Appropriate use of antibiotics in the management of urinary tract infections in aged residential care.

Concurrent session:
Rationale: Prescribing antibiotics for those who do not need them can cause harm by increasing the risk of antimicrobial resistance in addition to having adverse effects on individuals such as diarrhoea, nausea, and allergic reactions. The Health Quality & Safety Commission (the Commission) partnered with the aged residential care (ARC) sector to reduce the total number of urinary antibiotic prescriptions for residents whose symptoms did not meet the criteria for urinary tract infection (UTI) in the nine participating facilities. This quality improvement (QI) project also focused on supporting systems improvement and building workforce capability.

Methodology: The Commission team, with input from sector experts, collected and reviewed information available nationally and internationally on appropriate use of antibiotics in the management of UTIs and drafted an implementation guide. The Commission partnered with nine facilities and project teams to upskill them on QI methods and tools. The project teams tested the interventions in the guide in their local environments for suitability and generalisability. Following four months of testing, information was collated, and the guide was finalised for sector use.

Results: A standardised definition for UTI was established as there had been variable criteria used across the project sites. Baseline data identified approximately 50% of residents received antibiotics for suspected UTIs where criteria for clinical symptoms were not present. As the interventions and decision support tool were implemented, a __% reduction in urinary antibiotic prescriptions was observed.

Conclusions: Specific interventions to identify and treat UTIs in older people showed benefit to ARC residents and decreased the overuse of antibiotics.

Recommendations: The opportunity for application of the interventions across all ARC facilities will ensure antibiotics are prescribed and administered for only residents that meet criteria. There is also potential for these interventions to be applicable for older patients in primary and secondary care.

Nikki has been employed at the Health Quality & Safety Commission since 2016. She started out as an infection prevention & control specialist and is now a senior manager in the Quality Systems Group which includes the IPC programme. She has 13 years of infection prevention, quality, and patient safety experience in the healthcare sector. Prior to working at the Commission, she managed and led the infection prevention and patient safety programmes for a health system in the U.S. Nikki has also worked as a research scientist in cancer biology and microbiology. She has a Master of Science degree in microbiology. Nikki relocated to New Zealand to enjoy the friendly people and spectacular scenery while continuing her career in infection prevention and control.

All Speakers