New doctors from carehome won't give antibiotics

[Toopie28]

Apologies if this has been asked.
I've had issues with Ma's GP and then we changed and she is in a carehome now. (there's a thread on uneducated GP's)

Ma is prone to UTI's and she's acting strange again (delirium) so I've asked for a urine sample to see if she has infection.
The carehome staff said that they can get a sample but it's up to the doctors as to if they will test it.
They said that the doctors will not prescribe antibiotics anymore unless it's severe.
Surely this is not the case? Don't they have a duty of care to ensure that people are comfortable as well as ensure they don't get worse? Test it and THEN let's talk but NOT to test??

I'm going to look it up and get my evidence prepared for the conversation but just wondering if anyone has had this particular battle with carehome doctors. Thanks

 

[SAP]

I find that sometimes what one person has said then gets changed a bit with each re telling . Always best to go straight to the appropriate person, in this case the GP. I know they are very careful about antibiotics for the general public but utis in a care home setting is quite different.

 

[sdmhred]

I’m having slight issues with the home GP but on mum’s rare condition so a bit different.

Here the nurses test if they are concerned (and would do a test if I asked)……the GP seems more than happy to px antibiotics quickly so they don’t end up severe and need hospital.

how prone is ur mum? She should have consideration for preventative action if more than 3 in 6 months I think ???

 

[Kevinl]

Well get mad, duty of care, hypocrathetic oath, all doctors take that, the duty to preserve life not to go for the lazyy way out for them.
I guess dealing with the old and frail it's an easy option but not something I could do, where there's life there's hope. K

 

[maggie6445]

Apologies if this has been asked.
I've had issues with Ma's GP and then we changed and she is in a carehome now. (there's a thread on uneducated GP's)

Ma is prone to UTI's and she's acting strange again (delirium) so I've asked for a urine sample to see if she has infection.
The carehome staff said that they can get a sample but it's up to the doctors as to if they will test it.
They said that the doctors will not prescribe antibiotics anymore unless it's severe.
Surely this is not the case? Don't they have a duty of care to ensure that people are comfortable as well as ensure they don't get worse? Test it and THEN let's talk but NOT to test??

I'm going to look it up and get my evidence prepared for the conversation but just wondering if anyone has had this particular battle with carehome doctors. Thanks

Not just care home doctors. Our GP is reluctant to do urine tests as well. I reckon there's some NHS directive about when to test because they used to.

 

[Rayreadynow]

My understanding is that a GP's contract no longer has to support visits to Care Homes and now Advanced Nurse Practitioners visit.

 

[sdmhred]

You are right @maggie6445
I think the dipstick tests are less encouraged these days (especially in care homes and elderly) as those without other symptoms can test positive for a mild infection which may lead to overuse of antibiotics.
But I have to say on the ground in the homes i have seen this isn’t happening.
But if @Toopie28 mum is signs of delirium that must be taken seriously!

 

[Toopie28]

I’m having slight issues with the home GP but on mum’s rare condition so a bit different.

Here the nurses test if they are concerned (and would do a test if I asked)……the GP seems more than happy to px antibiotics quickly so they don’t end up severe and need hospital.

how prone is ur mum? She should have consideration for preventative action if more than 3 in 6 months I think ???

You are right @maggie6445
I think the dipstick tests are less encouraged these days (especially in care homes and elderly) as those without other symptoms can test positive for a mild infection which may lead to overuse of antibiotics.
But I have to say on the ground in the homes i have seen this isn’t happening.
But if @Toopie28 mum is signs of delirium that must be taken seriously!

She's had much more than that (maybe once a month - once needed 2 sets of antibiotics back to back) and I did let them know this (care-home).

@maggie6445 - must be cost then. Well I could pay for it but to just say, no we won't test and if we find something then no antibiotics - just shaking my head (again) at this one.

I'll update. Everything is a fight as you all know. I've told the team leader of the home to let me know and I'll speak to the doctor directly.

Wondering if I can even go private if need be?

 

[sdmhred]

If she has that many UTI definitely ask GP about prophylactic. There is a drug out there called hiprex which has started to be used for this purpose. It’s non antibiotic and changes the pH of the urine to discourage bacteria growth. I would def be following this up - I get annoyed how UTI seen as inevitable in the elderly. There’s much that can be done!

 

[Toopie28]

If she has that many UTI definitely ask GP about prophylactic. There is a drug out there called hiprex which has started to be used for this purpose. It’s non antibiotic and changes the pH of the urine to discourage bacteria growth. I would def be following this up - I get annoyed how UTI seen as inevitable in the elderly. There’s much that can be done!

Oh wonderful, thanks so much for that! I will ask.

Elder care just seems to be getting more awful as time goes on. It just breaks my heart.

 

[maisiecat]

Hi @Toopie28, it can't be a cost issue as first line antibiotics for UTI only cost pence. It definitely sounds like your Mum is not being given enough antibiotic to clear the infection. Back to back infections are much more likely to be uncleared infection rather than a reinfection. I don't suppose that they would contemplate another test when she completes her course.
I also think that a prophylactic could help but one of the problems with elderly ladies is there urethral tissues are so oestrogen deprived that there are much more prone to infections.
Aiso dipsticks are not reliable on the elderly the urine needs to go to a lab to be cultured.
Sadly there is very patchy care for the elderly but if you have a problem with the Homes GP I would try and speak to him/her yourself. Information from Care homes can be like chinese whispers

 

[Toopie28]

Hi @Toopie28, it can't be a cost issue as first line antibiotics for UTI only cost pence. It definitely sounds like your Mum is not being given enough antibiotic to clear the infection. Back to back infections are much more likely to be uncleared infection rather than a reinfection. I don't suppose that they would contemplate another test when she completes her course.
I also think that a prophylactic could help but one of the problems with elderly ladies is there urethral tissues are so oestrogen deprived that there are much more prone to infections.
Aiso dipsticks are not reliable on the elderly the urine needs to go to a lab to be cultured.
Sadly there is very patchy care for the elderly but if you have a problem with the Homes GP I would try and speak to him/her yourself. Information from Care homes can be like chinese whispers

Mmmm, good to know - thank you.

Yes, I have an appointment to speak with the GP next week. We'll see how that goes. Thanks again!

 

[Toopie28]

Just wanted to update this.
After speaking with the doctors, they claim that they also depend on the home to determine IF the resident has an infection and needs to be tested. They told me that the care home leader has made the decision to NOT pursue a test as she does not believe that Ma is showing any symptoms.

I spoke to the team leader - she has 31 years experience she says. and in her opinion Ma does not show any pain and they usually do. She's eating and drinking and seems ok. She has no fever . Apparently the confusion and agitation is a change in her dementia. I told her that she never showed any of the above when she had them but she was more confused and agitated.

So she's gone from having 4 urine infections in 6 month. Been in the carehome for about 3 months now and it's not an infection.

Honestly, I just give up 🫤

 

[sdmhred]

Oh @Toopie28 I feel your pain! Decline in dementia or general decline is always an easy cop out! I’ve heard it many a time when I’ve been rightly convinced mum is unwell.
What happens to ur mum if she is left without treatment for her UTI? Does she eventually go on to get a fever or something?

Today I was told no need to put mum on commode as she had done some poo in the pad….uh there’s probably more to come I said…oh no quite a lot was the reply ………in come the night staff…would you please put mum on the commode…..they were quite happy to and out came a whoppa….

General moral of the story: professional carefs always see themselves as right and family carers as fussy worriers and will generally take the easy less hassle option…the truth: family carers know their cared for inside out!

 

[maisiecat]

Just wanted to update this.
After speaking with the doctors, they claim that they also depend on the home to determine IF the resident has an infection and needs to be tested. They told me that the care home leader has made the decision to NOT pursue a test as she does not believe that Ma is showing any symptoms.

I spoke to the team leader - she has 31 years experience she says. and in her opinion Ma does not show any pain and they usually do. She's eating and drinking and seems ok. She has no fever . Apparently the confusion and agitation is a change in her dementia. I told her that she never showed any of the above when she had them but she was more confused and agitated.

So she's gone from having 4 urine infections in 6 month. Been in the carehome for about 3 months now and it's not an infection.

Honestly, I just give up 🫤

Hi @Toopie28, as you rightly know you have been given a lot of misinformation. The elderly rarely have pain with a UTI confusion is the sympton to watch out for and also odour as the urine is stronger. Dipsticks and even laboratory tests are not always gold standard as its difficult to get a truly uncontaminated specimen. Also fever is not common with a UTI it is more seen if the infection has tracked up to the kidneys and also the elderly don't always get fevers even with severe infection. Also the modern trend for 3 days antibiotics is only suitable for the young, quite dangerous for the elderly.

 

[Toopie28]

Oh @Toopie28 I feel your pain! Decline in dementia or general decline is always an easy cop out! I’ve heard it many a time when I’ve been rightly convinced mum is unwell.
What happens to ur mum if she is left without treatment for her UTI? Does she eventually go on to get a fever or something?

Today I was told no need to put mum on commode as she had done some poo in the pad….uh there’s probably more to come I said…oh no quite a lot was the reply ………in come the night staff…would you please put mum on the commode…..they were quite happy to and out came a whoppa….

General moral of the story: professional carefs always see themselves as right and family carers as fussy worriers and will generally take the easy less hassle option…the truth: family carers know their cared for inside out!

Hi @Toopie28, as you rightly know you have been given a lot of misinformation. The elderly rarely have pain with a UTI confusion is the sympton to watch out for and also odour as the urine is stronger. Dipsticks and even laboratory tests are not always gold standard as its difficult to get a truly uncontaminated specimen. Also fever is not common with a UTI it is more seen if the infection has tracked up to the kidneys and also the elderly don't always get fevers even with severe infection. Also the modern trend for 3 days antibiotics is only suitable for the young, quite dangerous for the elderly.

Isn't it awful?
On one hand they say, you have to step back and let us do our job. But they are not doing it!
It's also due to the doctors telling them NOT to come to them with an infection unless it's "evident".
I left yesterday feeling so helpless and defeated. I mean, it's a 5 second test to ensure that the person is ok. I'm not asking for a scan or blood test, just a simple urine test!

@sdmhred, once she has a fever it's too late. IF she has a fever. Like @maisiecat said, they don't always get fevers. And case in point - you know your mum. But they have so much "experience" - there is no one size fits all.

I'm going to try and actually take it myself to a pharmacy and see what they say.

 

[sdmhred]

Ah I think now I understand …
there has been a call not to use dipsticks on the elderly as they will often show positive when there isn’t active infection and they don’t want over use of antibiotics- so GP waiting for ‘evidence’ BUT YOUR EVIDENCE is that she is more confused 😬😬😬 and you know her best. …

Im a little surprised at how care homes just seem v accepting of lots of uti. I know they are very likely but there is stuff that can be done to prevent. i think i remember one study showing how increased tea breaks led to a real decline in infection due to fluid increase …..I also think the diet in care homes Sometimes not great in that regard.

i hope u get some progress - u certainly don’t want it progressing any further - very stressful for you 😢

 

[Unknowndaughter01]

My understanding is that a GP's contract no longer has to support visits to Care Homes and now Advanced Nurse Practitioners visit.

Change GP , you are not obligated to use the care homes gp