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Join #AMREoE https://www.sli.do/
to poll and add questions
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Reducing Inappropriate Antibiotic
Prescribing by 50% by 2020 - A Whole
Health Economy Approach
East of England network 19th May 2017
Elizabeth Beech Pharmacist - NHS Bath and North East Somerset CCG National Project Lead Healthcare Acquired Infection and Antimicrobial Resistance - NHS Improvement [email protected] @elizbeech
mailto:[email protected]
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AMR IPC HAI - a whole health economy
approach to stewardship
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Cornwall AMR Group (CARG)
Neil Powell & Ian Davidson
CARG: Education and engagement with healthcare workers & vets One Health AMR conference at the Eden Project
Two Drug and Bug nurse educators delivering IPC and AMS education. GP Prescribing Lead meetings. Dental CPD session June 2017 to launch PHE dental toolkit Large animal CPD session - antibiotic consumption data collection. Small animal CPD session set audit standards. Antibiotic Guardian Campaign
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www.england.nhs.uk
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And there are no new
antibiotics in the pipeline
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Antibiotic consumption links to AMR
G7 Health Ministers meeting Oct 2015
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Review on Antimicrobial Resistance
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Superbugs to kill 'more than cancer' by 2050
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www.england.nhs.uk
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In the UK
If we fail to act, we are looking at an almost unthinkable scenario
where antibiotics no longer work and we are cast back into the dark
ages of medicine David Cameron, when UK Prime Minister
Fears grow over increased
antibiotic resistance
BBC 16 October 2015 UK experts said the study confirmed
their fears that antibiotic resistance
would affect routine surgery.
England's chief medical officer has
called the issue a ticking time bomb
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www.england.nhs.uk
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UK 5-year AMR Strategy 2013-18:
Seven key areas for action
Presentation title - edit in Header and Footer
PHE Human health
DH High Level Steering Group
Defra Animal health
DH
1) Better access to and use of
surveillance data
2) Optimising prescribing practice
3) Improving infection prevention and
control
4) Improving professional education,
training and public engagement
5) Improving the evidence
base through research
6) Developing new drugs,
vaccines and other
diagnostics and
treatments
7) Strengthening UK and
international
collaboration
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ARHAI Advisory Committee on Antimicrobial Prescribing,
Resistance and Healthcare Associated Infection
Quality measures published 2014
Advisory Committee on Antimicrobial Resistance and Hospital Acquired Infections (ARHAI) Recommended Antimicrobial Prescribing Quality
Measures. 2014. https://app.box.com/ARHAI-Minutes-Papers/1/2152374732/18606265032/1
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English surveillance programme for antimicrobial
utilisation and resistance (ESPAUR) report
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National incentive schemes
2015-2017
Quality Premium for improved antibiotic prescribing in primary care 2015-16 and 2016-17
Sepsis CQUIN 2015-16 & 2016-17 - systematic screening for sepsis and timely treatment
AMR CQUIN 2016-17 - Reduced antibiotic consumption in acute trusts & improved stewardship review 2016-17
2017-2109
CQUIN 2017-19 - Reducing the impact of serious infection
Quality Premium 2017-19 - Reducing Gram Negative Bloodstream Infections (GNBSIs) and inappropriate antibiotic prescribing in at risk groups
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Primary care prescribing of oral antibiotics in
2013-14 by CCG 36.5million prescriptions
0.000
0.200
0.400
0.600
0.800
1.000
1.200
1.400
1.600
1.800
2.000
0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0
Number of antibacterial items per STAR-PU
Number of co-amoxiclav, cephalosporin and quinolone items as a percentage of selected antibacterial items
Plot of the number of antibacterial items per STAR-PU versus the proportion of co-amoxiclav, cephalosporin and quinolone items by England CCGs 12 month period Oct13 - Sep14
England median value = 11.3%
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What worked well? How did the CCG AMR
Quality Premium perform in FY 2015-16? 182 CCGs met both metrics; 26 met one metric; 1 met neither
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Exceeded the 1% reduction target
Thank you!
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Primary care prescribing of oral antibiotics in
2016-17 by CCG 34.5 million prescriptions
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Sustained reduction? How is the AMR
Quality Premium performing FY 2016-17 145 CCG met both metrics; 63 met one metric; 1 met
neither
Continued reduction Sustained reduction but not continued
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CCG variation in antibacterial prescribing
22
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And GP practice variation in antibacterial
prescribing as well CMO letter sent to Top
20% GP practices 2016 & 2017
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GP prescribing of broad spectrum antibiotics has
been reducing consistently in Cambridgeshire
and Peterborough
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NHS activities delivering AMR improvement Collaborate and champion
Chief Pharmaceutical Officer now SRO 2017
NHS England Patient Safety Team national HAI & AMR leads 2014
Collaborative working Public Health England, NHS England, NHS
Improvement, Health Education England, Royal Colleges etc.
Guidance and resources
Update 2008 Health & Social Care Act Code of Practice
NICE guidelines NG15: Antimicrobial Stewardship
NHS Patient Safety Alert August 2015 promoting Start Smart then Focus and
TARGET stewardship resources & prescribing competencies
HEE integrating into undergraduate education & workforce e-lfh training module
PHE Behavioural Insights Team testing interventions
PHE AMR Portal publishes AMR, HAI, AMS, IPC metrics as open data
Incentivise, support and empower
Incentivise via National NHS schemes CCG Quality Premium & CQUIN
National workshops to engage, catalyse rapid action & share learning
Innovative use of primary care prescribing data do it once
PrescQIPP Antimicrobial Stewardship Hub collaboration go with the footfall
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So what works in primary care settings?
Prevent Infection
Maximise vaccination, particularly flu; handwashing; hydration; excellent
continence care; EVERYWHERE
Informed Patients
Consistent messaging about what does/not need antibiotics; analgesia
PHE TARGET PIL resources including safety netting and self care
Educated and AMR aware staff
TARGET webinars; HEE resources; Local expert educational events
Guidelines - Evidence based, accessible & user friendly, up to date!
Audit but hard to do well if consultations are not well coded!
Diagnosis use clinical decision support tools & build them into systems
Back-Up Antibiotic strategies with TARGET PIL
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What happens to amoxicillin prescribing when flu
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NHS | Presentation to [XXXX Company] | [Type Date] 2
8
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Maximising vaccination in Bath & North East
Somerset
Every contact counts childhood immunisation sticker
Book bagging in Key Stage 1
40% uptake vs 33% national
2016-17 school nurse delivery 70%
Men ACWY reminder in A levels results
Pharmacist at the University Freshers Week stall
52% uptake vs 35% national
Flu Myth Busters for health & social care workforce 2016
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Maternal deaths from influenza
room to improve uptake - 50%
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National Antimicrobial Stewardship Toolkits
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HEE AMR learning materials
http://www.e-lfh.org.uk/programmes/antimicrobial-resistance/
@NHS_HealthEdEng
#antimicrobialresistance #AMR
http://www.e-lfh.org.uk/programmes/antimicrobial-resistance/http://www.e-lfh.org.uk/programmes/antimicrobial-resistance/http://www.e-lfh.org.uk/programmes/antimicrobial-resistance/http://www.e-lfh.org.uk/programmes/antimicrobial-resistance/http://www.e-lfh.org.uk/programmes/antimicrobial-resistance/http://www.e-lfh.org.uk/programmes/antimicrobial-resistance/mailto:[email protected]:[email protected]
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TARGET: patient information leaflet
34 Antimicrobial Stewardship Tools NHSI_PHE #AMSWorkshop Dr Diane Ashiru-Oredope
Adapted version now available for community pharmacists and OOH