antimicrobial resistance cquin 2019-2020€¦ · antimicrobial resistance cquin 2019-2020 improving...

Antimicrobial Resistance CQUIN 2019-2020Improving antibiotic prophylaxis for elective colorectal surgery & improving the management of lower UTI in older people27th February 2019

Emma CrampNHS Improvement – Quality Improvement [email protected] @EmmaCramp

mailto:[email protected]

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• 2018-2019 Antimicrobial Resistance CQUIN • Background • Urinary Tract Infections• Surgical Prophylaxis• Antibiotic Consumption• Where to find information for 2019-2020 CQUIN• Key areas to focus on to help achieve CQUIN 2019-2020

Contents

Antimicrobial Resistance & Stewardship CQUIN 2019-2020

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2018-19 AMR CQUIN


CQUIN Indicator Percentage of Acute Trusts meeting 2d CQUIN Targets in Q2 18/19

Carbapenems 69.7% (76/109)

Total Antibiotics 34.9% (38/109)

Proportion Access 33.0% (36/109)

70.8%

Abx Rx72 hour review

Appropriate

clinician

IV to PO review

Q2 18/19 data – PHE Fingertips

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• Two national ambitions1. Halving inappropriate antibiotic

prescribing by March 20212. Halving healthcare associated Gram

negative blood stream infections by March 2021

Background


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• 2016 national PPS found 43.1% of surgical prophylaxis prescriptions were deemed to be inappropriate in terms of treatment duration

• 1098 surgical prophylaxis prescriptions for antibiotics

• This figure was even higher in digestive tract surgery (68.6%)

Background


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• Scotland implemented a surgical prophylaxis indicator• From April 2011 to September 2013• Target of >95% of sampled cases given a single dose of a policy compliant

antibiotic for elective colorectal patients• Median compliance for single doses was found to be 98% and 93%

compliance with antibiotic choice• 100% of boards submitting data achieved ≥95% compliance with the

measure “Single Dose” and 70% of the boards submitting data achieved ≥95% compliance with the measure “Antibiotic Choice Compliant with Policy”.

• Data for approximately 6,000 patients

Background


Data not published. Personal communication from NHS Healthcare Improvement Scotland

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• 2016 national PPS found 62.5% of lower UTI prescribing was inappropriate

• Approximately 54% of GNBSIs are E.coli

• Urinary tract is the main source of infection of E.coli BSIs

• Infection management - Joins up diagnostic stewardship with IPC and AMS

Background


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• Improving the diagnosis and management of lower UTI in older people

• Move towards simplification of the CQUIN indicators

• Antibiotic prescriptions for adult patients treated for lower urinary tract infections to be compliant with NICE guidance (NG109) and PHE Diagnosis of UTI guidance in terms of diagnosis for older people

• Data collection tool from NHSI/PHE and stakeholders

• Submit quarterly data to PHE via the online portal

• Minimum (60%) and maximum (90%) thresholds to receive payment

• Minimum level defines 0% payment and maximum defines 100% payment

• Payment for performance between these levels will be smoothly graduated without the need for defining partial payment thresholds. For example, a performance of 80% would result in ((80-60)/(90-60))*100 = 66.6% payment

Urinary Tract Infection


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• Improving appropriate antibiotic surgical prophylaxis in elective colorectal surgery

• Antibiotic surgical prophylaxis prescribed for colorectal surgery to be a single dose (or further doses if >1.5L blood loss, infection/contamination found during surgery or prolonged length of surgery) and prescribed in accordance to local antibiotic guidelines.

• Data collection tool from NHSI/PHE

• Submit quarterly data to PHE via the online portal

• Auditing two data fields: number of doses and antibiotic choice in line with local hospital guidance

• Both indicators: Recommendation for junior doctors or ward pharmacists to collect the audit data to allow antimicrobial teams to focus on QI

Surgical Prophylaxis


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• Carbapenem and Access category indicators have been removed to simplify the CQUIN

• Total antibiotic consumption target has moved to the NHS Standard Contract• Commissioners will be provided with information in order to ensure acute trusts

remained focused to reduce antibiotic prescribing• Baseline: Calendar year 2018• Target: 1% reduction over the financial year 2019/2020

• PHE will automatically use consumption data from RxInfo Define® through data sharing agreements between NHS acute trusts and PHE.

• NHS acute trusts that believe there are discrepancies between RxInfo Define®

data and data from internal pharmacy dispensing systems may submit data directly to PHE

Antibiotic Consumption


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• CQUIN indicator specification and NHS Standard Contract specification can be found on the NHSE website

• The following information can be found on the NHSI website:• FAQs

• UTI and SP data collection tool

• UTI and SP submission portal (total antibiotic data via collection tool if discrepancies in data)

• Total antibiotic baseline data (calendar year 2018) and target

Where to find 2019/20 CQUIN information


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• Improving the diagnosis and management of UTI is an NHS AMR diagnostic priority

• Collaboration with IPC, AMS, Microbiology

• SAPG/Healthcare Improvement Scotland – Good Practice Recommendations for Surgical and Procedural Antibiotic Prophylaxis in Adults

• In development – ToDipOrNotToDip improvement toolkit for system wide use

• Use of quality improvement approach

• Using data and information for action

• Behaviour change

• Education & training of all clinical staff to ensure documentation and appropriate use of antimicrobials

• Regular but varied communication on progress

• Local education and training at ward level

• Strong and effective multidisciplinary leadership (champions) at all levels

Areas to focus on…


antimicrobial resistance cquin 2019-2020€¦ · antimicrobial resistance cquin 2019-2020 improving...

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