Improving Safety & Quality of Antimicrobial Prescribing in Berkshire HFT Kiran Hewitt, Lead Clinical Pharmacist (Project Lead) Jenny Perry, Senior Pharmacist (Project Manager)

IS THIS THE END? Antibiotic resistance now 'global threat', WHO warns GPs 'over- prescribing' antibiotics, says Cardiff University study THE WHITE HOUSE ORDERS PLAN FOR ANTIBIOTIC RESISTANCE Growing resistance to antibiotics a “truly global issue” CAST BACK INTO DARK AGES OF MEDICINE, WARNS CAMERON

Statistics (1) Number of bloodstream infections  from 2010 – 2013 Those caused by E.Coli rose by 12% Infections resistance to E.Coli  proportionally 25,000 people die each year across Europe Year on year  in antibiotic prescribing in UK – 36% of patients were given antibiotics for coughs and colds in % by 2011

Statistics (2) Between 2010 and 2013:  Antibiotic use  by 6%  general practice prescribing  by 4%  prescribing to hospital inpatients  by 12%  other community prescriptions (dentists, out of hours prescribers, nurses, NMPs)  by 32%

Statistics (3) In 2013, 27.4 out of every 1,000 inhabitants in England were taking a prescribed dose of antibiotics each day, with 79% of these prescriptions occurring in general practice, 15% in hospital and 6% being other community prescriptions (predominantly dentists). (Regional variable statistical data available from ESPAUR report)

Global Action World Health Assembly (WHA) 2014 resolution WHO Global AMR Security Agenda: AMR action package Transatlantic Taskforce on AMR - TATFAR – US & EU collaboration

National Actions (1)  UK 5 year antimicrobial resistance strategy  ESPAUR  PMs commission on ABR by the Wellcome Trust  EAAD 18/11/14  RPS – promoting AMS through CPD and its practice standards

National Actions (2) Summit held on 6 th Nov Coalition of 5 health leadership organisations – RPS – RCP – RCGP – RCN – Faculty of PH

National Actions (3) NICE Guidelines – processes for effective antimicrobial medicines (May 2015) NICE Public Health Guidelines Antimicrobial Resistance (May 2016) NHS Outcomes Framework – “Reducing healthcare associated infection” MRSA & C Diff. – attributed to inappropriate AB prescribing

So What? Antibiotic prescribing and antibiotic resistance are inextricably linked; overuse and incorrect use of antibiotics are major drivers of resistance Geographical areas of high prescribing = high resistance Advice = audit and compare trends

Background to Project Berkshire Healthcare NHS Foundation Trust: A county-wide MH secondary care provider + CHS from 2011 Trust wide antimicrobial audit – Part of annual audit plan – Nov-13

Audit Standards & Results Criteria Audit Criteria – Standards = 100% Findings 1 Relevant cultures will be taken before antimicrobial therapy is started 49% 2 Drug allergies (antimicrobials) will be noted on the chart 74% 3 Route of administration will be indicated on the chart 98% 4 Dose and frequency will be indicated on the chart 97% 5 The antimicrobial start date will be noted on the chart 85% 6 The duration will be noted on the drug chart 77% 7 Indication will be noted on the chart 47% 8Treatment will be in line with trust guidelines83%

Actions Proposed Leadership role (pharmacist) to drive stewardship across the Trust Better access to guidelines – to support remote working Training and better education of prescribers - main focus of action plan and internal self assessment Use of technology to enhance the deliver of these Networking and regional collaboration with subject experts – Membership of TVWAPN (sub group of Chief Pharmacists group) Guidelines review in collaboration with both local hospitals PSF bid made April 2014 and was successful

Project Work to Date (1) Recruitment of Project Manager Sept-14 Purchase, training and development of Microguide smartphone app – Sept to Nov-14 Key Benefits:

Project Work to Date (2) Promotional Plan – Infection Control and Comms teams – EAAD work Face to face intro for staff Presentation at the Trust Quality Improvement Conference Link Practitioners Study Day presentation

Work Plan (1) E-learning package introduction Original plan – regional module to utilise local and regional expertise = best option Delayed launch – Options appraisal for alternatives – Bespoke Trust package in development with L&D – For Jan 15 release

Development of Roll Out Programme – introduction, comms and implementation Training managed through L&D Measure change interventions (small scale) as part of roll out programme, reflect Re-audit Feb/Mar-15 – X% improvement in outcomes and KPIs – Dependent on initial ‘test’ improvements Work Plan (2)

Work Plan (3) Spread improvement strategy across Berks – CCG colleagues – Primary Care - GPs, out of hours practitioners, Westcall – Share own work with regional group and promote development of consistency of standards Ongoing audit of App access and training

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