Strategies to Improve Antibiotic Use Flashcards
What are patients with infections caused by drug resistant bacteria generally at an increased risk of? (WHO 2014)
Worse clinical outcomes and death
What accelerated the emergence of drug resistant bacteria?
Use and misuse of antimicrobials
Poor infection control practices
Inadequate sanitary conditions
Inappropriate food handling
What is antimicrobial stewardship?
Making the best use of antimicrobials to manage infection, so as to ensure optimal outcomes and minimal hard to patients and the wider society
Examples of antimicrobial stewardship programmes
Education IV to oral SWITCH Streamlining or de-escalation PK/PD dose optimisation Guidelines and clinical pathways Antimicrobial order forms
What are the aims of the UK 5 year antimicrobial resistance strategy?
Improve knowledge and understanding of AMR
Conserve and steward the effectiveness of existing treatments
Stimulate the development of new antibiotics, diagnostics and novel therapies
Roles of the Scottish Antimicrobial Prescribing Group
Coordinate and deliver a national framework for antimicrobial stewardship to enhance the quality of antimicrobial prescribing and management in Scotland
Contributed to decreased CDI rates in Scotland
Development of new data systems for quality improvement
Development of training materials on AMS
Improved clinical management of infections
Scottish Government targets for quality indicator
Level 3 for primary care
Antibiotic use in at least 50% of practices in each NHS board will be at or below the 25% percentile of Scottish practices or have made an acceptable move toward that level by April 2016
NHS Grampian strategies
Policies and guidelines
Audits and feedback
Surveillance data
Education
Acute policies and guidelines
Empirical guidelines Documentation and review/stop date IVOST policy Penicillin allergy Alert antimicrobials Gentamycin Vancomycin
When should you consider switching patients from IV to oral antibiotics?
After 48 hours, provided that the patient is improving clinically and is able to tolerate an oral formula
What criteria must be met to switch patients from IV to oral antibiotics?
Able to swallow and tolerate fluids
Temperature of 36-38 for at least 48 hours
Heart rate < 100 bpm for previous 12 hours
WCC between 4 and 12 x 10^9 L
What are alert antimicrobials?
Antimicrobials for restricted use only under the authorisation of a microbiologist or infectious diseases/other relevant specialist
How are alert antimicrobials prescribed?
According to approved indication within local guidelines/policies
Primary care strategies to improve antimicrobial use
Empirical guidelines
Delayed prescriptions
Non-prescription pads
Patient information leaflets on management of e.g. self-limiting URTI, cystitis
Education strategies to improve antimicrobial use
Regular training sessions for medical students and junior doctors Recent focus on UTI training for nurses Online resources Primary care event General public education
