local actions to tackle antimicrobial resistance

Local actions to tackle antimicrobial resistance (AMR)

Faculty of Public Health Conference15 June 2016

Dr Diane Ashiru-OredopePharmacist Lead; Antimicrobial Resistance ProgrammePublic Health EnglandTwitter - @DrDianeAshiru #AntibioticGuardian

Ms Thara Raj

Antimicrobial ResistanceA major threat to future healthcare -

clinical, public health and economic implications

Antimicrobial use is a recognised driver

Clinically (all conditions) - appropriate prescribing improves patient outcomes

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The future if we do not act now

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By 2050: more deaths from resistant infections compared to e.g. cancer

http://amr-review.org/

Antimicrobial Resistance Dr Diane Ashiru-Oredope



Non-susceptibility (%) among (a) E. coli, (b) Klebsiella spp. and (c) Enterobacter spp. from bacteraemias in England, Wales and Northern Ireland, as reported to PHE-LabBase.

Livermore D M et al. J. Antimicrob. Chemother. 2013;jac.dkt212

© The Author 2013. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: [email protected]

Cephalosporins, diamonds; ciprofloxacin, squares; gentamicin, triangles Antimicrobial Use

is a driver for resistance

AMR: individual riskRisk of resistance persists for at least 12 months in

individuals after each intake of an antibiotic

Increased risk of resistant organism

Antibiotic in past 2 months

Antibiotic in past 12 months

UTI 5 studies: n = 14,348 2.5 times 1.33 times

RTI7 studies: n = 2,605 2.4 times 2.4 times

A meta analysis of English Primary CareCostello et al. BMJ. (2010) 340:c2096.

5 Antimicrobial Resistance Dr Diane Ashiru-Oredope 5

Tackling AMR:

• The government

• Professional bodies/organisations/Public health agencies and leads

• Healthcare professionals – human and animal health

• The public

• Pharmaceutical companies

Antimicrobial Resistance Dr Diane Ashiru-Oredope 6 AMR; WLMHT Physical Health Conference Dr Diane Ashiru-Oredope

EVERYONE HAS A ROLE:

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Global action on AMR

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World Health Assembly 2014 resolution Global Health Security Agenda: AMR action package - mechanism and collaboration to accelerate implementation

WHO Global AMR Action Plan 2015 – framework for action


UK 5-year AMR Strategy 2013-18: Seven key areas for action

PHEHuman health

DH – High Level Steering Group (cross government)

DefraAnimal health

DH

1. Improving infection prevention and control2. Optimising prescribing practice3. Improving professional education, training

and public engagement 4. Better access to and use of surveillance

data

• Improving the evidence base through research

• Developing new drugs, vaccines and other diagnostics and treatments

• Strengthening UK and international collaboration

Impact of EAAD and Antibiotic Guardian Dr Diane Ashiru-Oredope & Ms Katerina (Aikaterini) Chaintarli EAAD and Antibiotic Guardian Dr Diane Ashiru-Oredope

Antimicrobial Resistance Dr Diane Ashiru-Oredope 8

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Antimicrobial Stewardship Tools NHSI_PHE

#AMSWorkshop Dr Diane Ashiru-Oredope

What tools are available:

10 Antimicrobial Stewardship Tools NHSI_PHE #AMSWorkshop Dr Diane Ashiru-Oredope

Antimicrobial stewardship toolkits: PHE in collaboration with several professionals and professional organisations

Antimicrobial Stewardship Tools NHSI_PHE #AMSWorkshop Dr Diane Ashiru-Oredope 11

Treating your infection

Never share antibiotics and always return any unused antibiotics to a pharmacy for safe disposal

TARGET LEAFLET – GP, OOH, Community Pharmacy

TREATING YOUR INFECTION LEAFLET: GPs; Out of Hours practice; Community Pharmacy• A leaflet for health professionals working in primary care to use when provide

advice to patients. The leaflet provides practical advice on how to treat symptoms of common self limiting infections and warning signs for serious illness.

Developed by Public Health England 12

E-Learning for Healthcare (HEE)

Antimicrobial Stewardship Tools NHSI_PHE #AMSWorkshop Dr Diane Ashiru-OredopeAMR; WLMHT Physical Health Conference Dr Diane Ashiru-Oredope

Free for all with NHS email address

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Open access for ALL

Antimicrobial Stewardship Tools NHSI_PHE #AMSWorkshop Dr Diane Ashiru-Oredope

Local Action to tackle antimicrobial resistance (AMR) using evidence and knowledge of seasonal peaks in demand

Seasonal prescribing patterns

15 AMR Local Indicator

Source: BBC News website 18.11.2015

How to effect change at a local level• Local ownership

• Antimicrobial stewardship

• Rigorous scrutiny and use of local indicators

• Financial incentives- quality premiums

• Leadership and innovation

• Demand management - engaging the public - tackling communicable diseases


PHE Fingertips Web Portal - Information for local action(http://fingertips.phe.org.uk/)

17 Antimicrobial Resistance Dr Diane Ashiru-Oredope

PHE Fingertips Web Portal


Published 5 April 2016


Domain Quality IndicatorsAMR • % of E. coli from blood tested for susceptibility to carbapenems

• Gram-negative BSIs and resistance to key antibiotics

Prescribing • Community prescribing (CCG)

HCAI • Mandatory bacteraemia surveillance data• Mandatory CDI surveillance data• Mandatory SSI surveillance data

IPC • ERIC data on single rooms/single rooms with ensuite (by Trust);• PLACE cleanliness scores• Healthcare worker influenza vaccination

AMS • Antibiotic Guardians per 100,000 population per year (CCG)• SSTF review and action plans (by Trust);

Examples of Local antimicrobial stewardship groups

Outer North East London AMR Stewardship

Group using NICE baseline assessment tool

to benchmark progress

Expanding to include inner North East

London


Southwark - method• Used audit tools to help local practices review

their overall volume of antibiotic prescribing and prescribing of broad spectrum antibiotics against local antibiotic guidelines.

• Focused reviews in a number of practices who were significant outliers in prescribing broad spectrum antibiotics.


Southwark - results


A reduction of almost 2% based on the 14/15 baseline

Quality Premium Indicator

Indicator unit of measurement

Baseline value 2014/15

Value for 2015/16 by quarter

Q1 Q2 Q3 Q4 Average

Broad spectrum antibiotics

% Items(Target set by NHSE ≤11.5%)

12.8

13.35

12.08

9.21

8.84

10.8

Newham - method• Launched a prescribing quality improvement scheme

• Developed local primary care antibiotic guidelines with neighbouring CCGs

• Visits to each practice to discuss prescribing data and outliers followed up

• Two education events

• Used RCGP accredited education materials/PHE TARGET toolkit

• Practices linked up with hospital microbiologists to address clinical queries


Newham - results


Quality premium indicators Target values CCG values (April 15 to Feb 16)

Number of antibiotics prescribed in primary care by 1% (or greater) from each CCG’s 2013/14 value

1.063 1.0

Number of co-amoxiclav, cephlosporins and quinolones as a percentage of the total number of selected antibiotics prescribed in primary care by 10% from each CCG’s 2013/14 value, or to be below the 2013/14 median proportion for English CCGs (11.3%)

14.05 10.03

Nurse leadership in a GP practice

“..when you are faced with an anxious or demanding patient in your clinic there is still pressure to prescribe”

Liz Cross, Practice Nurse, Attenborough GP Practice



“Everyone was followed up after 28 days and the numbers of patients who came back for a follow up appointment

halved and this was during the winter months”Liz Cross

Engaging with patients & the public

Developed by Public Health England

18th November

Awareness & engagement campaigns

EAAD (18th November) is an international collaboration with World Antibiotic Awareness Week and awareness weeks in

USA, Canada & Australia (16-22 November)

Australia Antibiotic Awareness Week

USA Get Smart without Antibiotics

Canada Antibiotic Awareness week

AMR: #AntibioticGuardian Roadshow Dr Diane Ashiru-Oredope Antimicrobial Stewardship Dr Diane Ashiru-OredopeImpact of EAAD and Antibiotic Guardian Dr Diane Ashiru-Oredope & Ms Katerina (Aikaterini) Chaintarli EAAD and Antibiotic Guardian Dr Diane Ashiru-Oredope 30 AMR: #AntibioticGuardian Roadshow Dr Diane Ashiru-Oredope

Educating the public: the value of awareness campaigns

Dr Diane Ashiru-Oredope31

Local Actions on public and healthcare professional awareness and engagement

Public Engagement – Devon County Council, Parents & Children’s centre

Educating the public: the value of awareness campaigns Dr Diane Ashiru-Oredope

The Listen to Your Gut campaign has been developed for parents by parents in conjunction with Devon County Council’s Public Health Team and My Start

Children’s Centre in Ilfracombe, which is run by Action for Children

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http://www.actionforchildren.org.uk/

EAAD & Antibiotic Guardian: children centres; hospitals; community pharmacies

University College London Hospitals

Awareness and engagement in Hospitals, community pharmacies, universities, organisations in all UK Countries

Educating the public: the value of awareness campaigns Dr Diane Ashiru-Oredope 34Educating the public: the value of awareness campaigns Dr Diane Ashiru-Oredope

Engagement via social media – e.g pictures tweeted with #AntibioticGuardian

Educating the public: the value of awareness campaigns Dr Diane Ashiru-Oredope 35Educating the public: the value of awareness campaigns Dr Diane Ashiru-Oredope


You are invited to become an Antibiotic Guardian today (available via mobiles)


Future: Sustainability and Transformation Plans (STPs)

To deliver plans that are based on the needs of local populations, local health and care systems came together in January 2016 to form 44 STP ‘footprints’.

To produce a multi-year Sustainability and Transformation Plan (STP) showing how together they will improve services

STPs are a key element on the NHS Shared Planning Guidance and the local implementation of the Five Year Forward View


https://www.england.nhs.uk/2016/03/footprint-areas/



https://www.england.nhs.uk/futurenhs/

https://www.england.nhs.uk/futurenhs/

Acknowledgements
