1. Clinical Engagement 15th July 2015 Robin A Howe
Antimicrobial use in Primary Care

2. Who to engage and why...

3. Improve the appropriate use of antimicrobials
Who to engage and why...
Improve the appropriate use of antimicrobials

4. Define their issue

6. c.Diff 2013/14

7. Show your issue

8. Total AB usage 2013

9. Link the issues

10. First gen ceph cefalexin and cephradine

11. All-Wales AB usage

13. Add an issue

14. Co-amoxiclav resistance in E. coli from Blood Cultures

17. Show that improvement possible

18. UHW Monthly C. difficile
New Antibiotic Policy

19. Llandough Monthly C. difficile
New Antibiotic Policy

21. Show local data

22. UHW Broad spectrum AB (DDDs)

23. MAU audit

24. Change in antibiotic guidelines
Reduce the use of Co-amoxiclav (Augmentin®)
The main aims of this change are
to reduce the current number of c.difficile cases,
to reduce resistance towards co-amoxiclav and
to improve overall antimicrobial stewardship
-removing a default “one size fits all” antibiotic option
New guidelines will recommend replacing co-amoxiclav with different antibiotics, depending on the indication
Doxycycline
Amoxicillin
Metronidazole
Gentamicin
Co-trimoxazole
ONE SIZE Fits all-antibiotic
- no brainer!

25. Show improvement

26. UHW 2013 PPS

27. UHW 2014 PPS

28. Four C’s

29. Meropenem and Tazocin spend

30. Llandough Monthly C. difficile
New Antibiotic Policy

31. UHW Monthly C. difficile
New Antibiotic Policy

32. Before introducing a change, know how you are going to measure the impact

33. Information available
Antibiotic usage data from pharmacy systems
Direct or via NWIS

34. Total AB usage 2013

35. Information available
Antibiotic usage data from pharmacy systems
Direct or via NWIS
Antibiotic usage data from annual PPS

37. Information available
Antibiotic usage data from pharmacy systems
Direct or via NWIS
Antibiotic usage data from annual PPS
Process measures from annual PPS

38. Reason for prescription recorded in notes

39. Treatment for >7 days

40. Surgical prophylaxis >24 hours

41. Information available
Antibiotic usage data from pharmacy systems
Direct or via NWIS
Antibiotic usage data from annual PPS
Process measures from annual PPS
Local audits of usage or process

42. Local feedback of data is important for supporting behaviour change

43. Simple usage data (Leeds)
Long term trends (12 mth)
Trust
Medicine
Onc-Surg
Spec Surg
WCHN
Total higher risk HCAI antibiotics
-16%
-18%
-20%
-11%
1st gen cephalosporins (CDI)
-30%
-33%
-43%
-47%
2nd gen cephalosporins (CDI)
-49%
-56%
-44%
-69%
-23%
3rd gen cephalosporins (CDI>MRSA)
-4%
-34%
73%
11%
Ciprofloxacin (MRSA>CDI)
-40%
-41%
-42%
-14%
Clindamycin
-21%
28%
-38
Co-amoxiclav (CDI)
57%
19%
93%
173%
139%
Meropenem (MRSA) 0%
-2%
18%
16%
Piperacillin-tazobactam (MRSA)
36%
42%
40%
25%
10% decrease
+/- 10%
>10% increase

44. Colour coding reports with recommendations (Norwich)
Speciality
No of Rx in audit
Duration – All prescriptions to include a stop/review date
Indication – All prescriptions to include recorded indication
Policy – All prescriptions in line with Trust approved policy/guidelines
Overall %
compliance
Division 1
Dermatology 1
100%
Endocrinology 3 0%
67%
56%
Gastroenterology 9
22%
78%
89%
63%
MFE 29
69%
90%
86%
Nephrology 15
93%
87%
Neurology 2
50%
84%
Respiratory 10
40%
70%
Division 2
Head neck/plastics
T & O
Vascular
96%
Overall compliance
All specialties 82
88%
99%
81%
% overall compliance
Colour
Action required
Recommended action
0% - 49%
Red
Organisational priority
Re-audit following week, escalate as per policy
50% - 70%
Dark amber
Urgent action required
Training, reminder slips and quarterly monitoring
71% - 99%
Light amber
Continue quarterly monitoring
100%
Green
Full compliance

45. Conclusions Lots of data is available
Presentation needs to be adapted to the audience and aim.
Snapshot data can have a message
Temporal data required to show or encourage change
Arprogramme happy to help with data supply and advise about presentation