Strategies to Improve Abx use

Question 1

Causes of drug resistance?

Answer 1

> No commitment
> Weak surveillance
> Poor drug quality
> Irrational drug use
> No infection control 
> Lack of research

Question 2

What occurs do to the misuse of antimicrobials?

Answer 2

Accelerates the emergence of drug-resistant strains

Question 3

What is antimicrobial stewardship?

Answer 3

“Making the best use of antimicrobials to manage infection so as to ensure optimal outcomes and minimal harm to patient and the wider society” (SAPD definition)

Question 4

What is the UK 5 year antimicrobial resistance strategy?

Answer 4

> Improve knowledge and understanding of AMR
Conserve and stewards the effectiveness of existing treatments
Stimulate and development of new antibiotics diagnostics and novel therapies

Question 5

Cochrane review 2017?

Answer 5

> Abx policies improve Abx Rx and decrease duration of use
Decrease length of stay and did no increase the risk of death
Advice/feedback more effective than restrictive interventions
Recommend using behaviour change techniques - audit and feedback

Question 6

What is the role of the Scottish Antimicrobial Prescribing Group (SAPG)?

Answer 6

Co-ordinates & delivers a national framework for antimicrobial stewardship to enhance the quality of antimicrobial prescribing & management in Scotland

Question 7

What are the successes of SAPG?

Answer 7

> Decreased CDI rates in Scotland
Development of new data systems for quality improvement
Development of training materials on AMS
Improved clinical management of infections e.g. CAP, Sepsis 6

Question 8

Scottish Governments targets in Abx use in primary care?

Answer 8

Antibiotic use, expressed in items/1000/day in at least 50% of practices in each NHS board will be at or below the 25th percentile of Scottish practices or will have made an acceptable move toward that level, Baseline has now changed to Jan – Mar 2016.

Question 9

Scottish Governments targets in Abx use in hospitals?

Answer 9

HEAT target – hospital prescribing
> Indication for antibiotic is documented and compliant with local policy
> Duration of oral antibiotics is documented and compliant with local policy

Current targets
> IV antibiotic review within 72h and outcome is documented
> 1% Reduction in overall antibiotic consumption
> 1% Reduction in carbapenem consumption
> 1% Reduction in piperacillin/tazobactam consumption

Question 10

What is the HEAT target in ABx use?

Answer 10

HEAT target – hospital prescribing
> Indication for antibiotic is documented and compliant with local policy
> Duration of oral antibiotics is documented and compliant with local policy

Question 11

Since 2012 what has been the trend in Abx use overall?

Answer 11

Decrease in 3% overall, however:
> Decrease in primary care
> Increase in acute hospitals

Question 12

Since 2012 what has been the trend in Abx in primary care?

Answer 12

> Decrease 1.7% since 2015

> Decrease 11.1% since 2012

Question 13

Since 2012 what has been the trend in Abx in hospitals?

Answer 13

> Increase 0.8% since 2015

> Increase in 10.2% since 2012

Question 14

NHS Grampian Strategies in Abx use?

Answer 14

> Policies and guidelines
Audits and feedback
Surveillance data
Education

Question 15

NHS Grampian Strategies in Abx use - policies and guideline?

Answer 15

1) Empirical guidelines
2) Documentation & review/stop date
3) IVOST policy
4) Penicillin allergy
5) Alert Antimicrobials
6) Gentamicin
7) Vancomycin

Question 16

Explain Drug Kardex Documentation?

Answer 16

1) Indication e.g. UTI
2) Duration of use
3) Line to indicate when the course is to end

Question 17

When should IV to oral switch therapy (IVOST) in ABx be used?

Answer 17

Consider after 48hrs provided:

1) The patient is improving clinically
2) Is able to tolerate an oral formulation

All these criteria must be met:
> Able to swallow and tolerate fluids
> Temp 36-38oC for at least 48hrs 
> Heart rate <100bpm for the previous 12hrs
> WCC between 4 and 12x10^9L

Question 18

When shouldn’t IV to oral switch therapy (IVOST) in ABx be used?

Answer 18

> Oral route compromised
> Continuing sepsis 
- Temp <36 or >38oC
- >90bpm HR
- >20breaths/min
- WCC <4 or >12

> Special indication:
- Endocarditis
- Meningitis
- S aureus
- Immunosuppression
- Cystic fibrosis
- Prosthetic infection 
etc

> Skin or soft tissue infection

> Febrile neutropenia

> Hypotension/shock

If yes to any of the review again after 12-24hrs

Question 19

Alert antimicrobials - Key points?

Answer 19

> Restricted use only under authorisation of microbiologist of infectious disease specialists (e.g. meropenem)

And/or

> According to approved indications within local guidelines/ policies
(eg ceftriaxone allowed for meningitis)

Question 20

Alert antimicrobials - Key points?

Answer 20

> Restricted use only under authorisation of microbiologist of infectious disease specialists (e.g. meropenem)

And/or

> According to approved indications within local guidelines/ policies
(eg ceftriaxone allowed for meningitis)

Question 21

What is a non-prescription pad?

Answer 21

A document used in primary care for patients seeking Abx who do not require them.

The document describes why Abx are not needed.

Question 22

Types of audits and feedbacks used in Abx use?

Answer 22

> Large point prevalence audits annually
SAPG quality improvement audits
Smaller ad-hoc audits

Question 23

Education uses on Abx use?

Answer 23

> For medical students and junior doctors
ScRAP
On-line resources e.g. NES, Learn pro, TURAS
European Antibiotic Awareness Day
General Public

Question 24

NHS Grampian successes in Abx use?

Answer 24

> Reduction in CDI
MRAS rates have fallen
ESBL rates relatively stable

Question 25

How can healthcare workers help to tackle AMR?

Answer 25

> Practicing effective infection prevention and control
Prescribing and dispensing antibiotics only when truly needed
Prescribing and dispensing the right antibiotic(s) for the right duration to treat illness

Question 26

How can everybody help to tackle resistance?

Answer 26

> Use Abx only when prescribed
Complete the full course
Never share antibiotics or use leftover prescriptions

Question 27

How can everybody help to tackle resistance?

Answer 27

> Use Abx only when prescribed
Complete the full course
Never share antibiotics or use leftover prescriptions