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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 elizabeth.beech@nhs.net @elizbeech

mailto:elizabeth.beech@nhs.net

AMR IPC HAI - a whole health economy

approach to stewardship

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

www.england.nhs.uk

And there are no new

antibiotics in the pipeline

Antibiotic consumption links to AMR

G7 Health Ministers meeting Oct 2015

Review on Antimicrobial Resistance

Superbugs to kill 'more than cancer' by 2050

www.england.nhs.uk

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

www.england.nhs.uk

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

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

English surveillance programme for antimicrobial

utilisation and resistance (ESPAUR) report

16

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

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%

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

Exceeded the 1% reduction target

Thank you!

Primary care prescribing of oral antibiotics in

2016-17 by CCG 34.5 million prescriptions

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

CCG variation in antibacterial prescribing

22

And GP practice variation in antibacterial

prescribing as well CMO letter sent to Top

20% GP practices 2016 & 2017

GP prescribing of broad spectrum antibiotics has

been reducing consistently in Cambridgeshire

and Peterborough

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

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

What happens to amoxicillin prescribing when flu

NHS | Presentation to [XXXX Company] | [Type Date] 2

8

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

Maternal deaths from influenza

room to improve uptake - 50%

National Antimicrobial Stewardship Toolkits

HEE AMR learning materials

http://www.e-lfh.org.uk/programmes/antimicrobial-resistance/

@NHS_HealthEdEng

#antimicrobialresistance #AMR

mohamed.sadak@hee.nhs.uk

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:mohamed.sadak@hee.nhs.ukmailto:mohamed.sadak@hee.nhs.uk

TARGET: patient information leaflet

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

Adapted version now available for community pharmacists and OOH