Antimicrobial Stewardship

 

nhs england logo

Welcome to the Antimicrobial Stewardship (AMS) Hub, hosted as part of a PrescQIPP collaboration with NHS Improvement to support CCG Quality Premium activity. This work has been led by Elizabeth Beech, Healthcare Acquired Infection and Antimicrobial Resistance Project Lead, Patient Safety Domain, NHS Improvement, who is responsible or the range of content available on this AMS Hub.

nhs improvement logoIn the sliders below you will find a selection of resources and links to help you better understand and navigate this key area of work for commissioners and providers alike.

 

The Role of NHS England in Antimicrobial Resistance Prevention

NHS England has seconded three healthcare associated infection (HCAI) and AMR project leads to work for the rest of the 2014/15 financial year. The project leads will provide specialist clinical advice on AMR and HCAI to support commissioners, strengthen existing clinical networks and collaboration with partner organisations.

Who is Who

Elizabeth Beech - Primary Care (elizabeth.beech@nhs.net)
Stuart Brown - Secondary Care (stuart.brown3@nhs.net)
Phil Howard - Community Pharmacy (philip.howard2@nhs.net)

Infection Prevention and Control and Antimicrobial Stewardship

Healthcare workers have a vital role in preserving the power of antimicrobials. Antibiotic prescribing and antibiotic resistance are inextricably linked. Overuse and incorrect use of antibiotics are major drivers of resistance. Inadequate hygiene and infection prevention and control measures help to spread infections.

The more we can do to prevent infections and control their spread, the more we will reduce the need for antibiotics and limit opportunities for antimicrobial resistant strains to develop. Where infections do occur we need to diagnose them quickly and use the antibiotics we have appropriately.

In December, 2010, National Health Service (NHS) England introduced national mandatory screening of all admissions for meticillin-resistant Staphylococcus aureus (MRSA). Public Health England published guidance on The Implementation of modified admission MRSA screening guidance for NHS (2014). This article reports an assessment of the effectiveness and cost-effectiveness of the 2010 policy, from a regional or national health-care decision makers' perspective, compared with alternative screening strategies. A review of the national MRSA screening programme has been published.

ECDC Evidence Brief – Update on the spread of carbapenemase-producing Enterobacteriacea in Europe.

What's New?

The articles below show new content added to the AMS Hub. 

Updated TARGET Antibiotics Toolkit - Guide to Resources

The TARGET Antibiotics Toolkit - Guide to Resources has recently been updated - you can view the guide to resources and supporting documens in the TARGET Antibiotics slider below.

FREE TARGET Antibiotic Webinars

Public Health England (PHE), the British Society for Antimicrobial Chemotherapy (BSAC), and primary care colleagues have developed seven free TARGET antibiotic webinars highlighting key easy actions you can take to help improve antibiotic prescribing, the patient journey and self-care, reducing future consultations. Professor Cliodna McNulty, Head of PHE Primary Care Unit will lead each session. 

Webinars start Wednesday 2 November 1:30 – 2:15 p.m. Full content and reading will be available after each session. 

For optimal viewing of the webinar please use either Safari or Chrome

REGISTER NOW for FREE TARGET antibiotic webinar series and gain 7 hours of CPD

 

Antimicrobial Stewardship Data - now available to public!

The AMS excel reports and AMS visual analytics produced by PrescQIPP in partnership with NHS England and NHS Improvement are now available to the public.

View on the data slider!

2016/17 CQUIN

There is a 2016/17 Antimicrobial Resistance CQUIN which has a stated Goal: Reduction in antibiotic consumption and encouraging focus on antimicrobial stewardship and ensuring antibiotic review within 72 hours based on the Rationale: Reducing consumption of antibiotics and optimising prescribing practice by reducing the indiscriminate or inappropriate use of antibiotics which is a key driver in the spread of antibiotic resistance.

New Provision of social norm feedback to high prescribers of antibiotics in general practice report added to Behaviour Change and Public Education Slider

Provision of social norm feedback to high prescribers of antibiotics in general practice: a pragmatic national randomised controlled trial - This is a report of the research that informed the decision to send CMO letters to the Top 20% antibiotic prescribing GP practices in January 2016.

Data

As part of the collaboration between NHS England and PrescQIPP to support CCG Quality Premium activity, PrescQIPP is supporting the development and production of two reports at CCG and practice level. You can now view the reports via the link below:

 Data and Reports - AMS

AMS Visualisations by PrescQIPP to Support the AMS Quality Premium Activities

In the two visualisations linked below, you'll find our interpretation of the reports that we have been producing over the last year as part of our collaboration with NHS E around Antimicrobial Stewardship. Please note that this is fully public domain data, from the NHS BSA Information Services Portal, and that is commonly used within the public domain - future visualisations will be restricted at the usual levels.

Antibacterial data quarterly practice level reporting against CCG QP targets (quarterly) - lots of useful info that you can explore and download, including Maps showing Antibacterial items/StarPU quintiles, and Maps showing % range of Co-Amoxiclav, Cephalosporins & Quinolones. Please note that whilst for the sake of insight and compraison we have applied CCG QP targets to practices in some visualisations, there are no national practice targets and local targets will likely differ.

 

Antibacterial data CCG monthly trend charts and CCG QP target monitoring (monthly) - similar to the above but focused on CCGs, with more regular progress. Includes area team viewing option, and ability to look at prescribing of chemical substances over time.

These can also be viewed in your web browser here

If you have any issues with the links not popping up please let us know - help@prescqipp.info - this function is new and hasn't been tested on all systems.

Click Here to Feedback on the Data

An Introduction to the Quality Premium

The Quality Premium is intended to reward clinical commissioning groups (CCGs) for improvements in the quality of the services that they commission and for associated improvements in health outcomes and reducing inequalities. There are new Quality Premium AMR CCG targets for 2016/17, and the guidance sets out the measures for 2016/17 and the levels of improvement for CCGs to achieve in order to qualify for the quality premium.

For more information please visit the NHS England webpage here.

NHS England have published the newly updated CCG improvement and assessment framework 2016/17, this contains the below:

  • Two new indicators under the Better Health Section
  • Anti-microbial resistance: Appropriate prescribing of antibiotics in primary care
  • Anti-microbial resistance: Appropriate prescribing of broad spectrum antibiotics in primary care.

CCGs are expected to demonstrate appropriate use of antibiotics, aligning with the 2016-17 AMR Quality Premium.

The Commissioning for Quality and Innovation (CQUINs)

There is a 2016/17 Antimicrobial Resistance CQUIN which has a stated Goal: Reduction in antibiotic consumption and encouraging focus on antimicrobial stewardship and ensuring antibiotic review within 72 hours based on the Rationale: Reducing consumption of antibiotics and optimising prescribing practice by reducing the indiscriminate or inappropriate use of antibiotics which is a key driver in the spread of antibiotic resistance.

To share examples of antimicrobial CQUINs developed for local use please contact elizabeth.beech@nhs.net

Bristol CCG CQUIN for community services provider

This is a NHS Bristol CCG CQUIN that was agreed with its community services provider (Bristol Community Health) in 2015/16. Bristol Community Health provides a range of services in the Bristol area (Community Matrons, District Nursing etc.) but notably also an Urgent Care Centre/Walk in Centre. Prescribing by Bristol Community Health is attributed to Bristol CCG, rather than to BCH itself as an independent sector healthcare provider. BCH prescribing therefore affects Bristol CCG’s Quality Premium achievement. Please he CQUIN is attached.

Please direct queries to jon.hayhurst@bristolccg.nhs.uk 

    BCH CQUIN – Quality Premium

Infographics

Share your Innovation, Audits and Education

As this page develops we will start to showcase great examples of work that has been done locally.

To share innovation and successful antimicrobial stewardship activities, audit programmes and educational resources here please contact elizabeth.beech@nhs.net

PrescQIPP Innovation Awards

PrescQIPP Annual Event 2016

For a second year we have a broad, yet dedicated category for projects that specifically focus and deliver outcomes around the critical area of patient safety.

Whilst we’ll be delighted to hear about any successful, innovative projects with a specific focus on safety, we’ll be paying a particular interest to any projects that align with helping achieve national objectives around medicines safety (i.e. reducing medication errors, Antimicrobial Stewardship, Acute Kidney Injury (AKI), acutely ill and/or frail elderly and HCAI.

Submission deadline: Friday, 9th September 2016

Find out more information on the Innovation Awards 2016 and details on how to enter!

For inspiration please take a look at the Innovation Award Winner for 2015 - At Scale Antimicrobal Stewardship In Primary Care and all other sumbissions for the Innovation Awards 2015.

Behaviour Change and Public Education

  • NICE have published a draft guideline Antimicrobial Resistance - Changing Risk-Related Behaviours in the General Population: Draft Guideline Consultation - This guideline covers interventions to change people’s behaviour to help reduce antimicrobial resistance and stop the spread of resistant microbes. Consultation closes 20 October 2015
  • The Wellcome Trust have published an excellent research based report into consumers attitudes to AMR and antibiotic use - Exploring the Consumer Perspective on Antimicrobial Resistance June 2015
  • Antibiotic Guardian NHS England is a proud supporter of European Antibiotic Awareness Day (EAAD). EAAD is held annually on 18 November as a European-wide event to raise awareness on how to use antibiotics in a responsible way that will help keep them effective for the future. European Antibiotic Awareness Day and Antibiotic Guardian resources can be found here and will be updated to support 2015 activity when available
  • Public Health England have commissioned roadshows on Antibiotic Guardianship that aim to deliver guidance, information and resources to health professionals. Resources to engage, promote and share Antibiotic Guardianship within the attendees’ organisation and with their stakeholders will be provided to delegates. The link for registration for these roadshows is here
  • e-Bug schools resource produced by Public Health England. This is an exciting, fun and free health education resource for teachers and school aged children. The resources make learning about microbes, antibiotic resistance, and the spread, treatment and prevention of infection fun and accessible for all. The e-Bug lesson plans can be used in biology and PSHE lessons, assemblies and health events. All lesson plans are in line with the National Curriculum and are free to download online here. We have partners in 27 countries and our resources are translated in 22 different languages. We need to teach children and young people about antibiotics as they are our future generation of users and prescribers. If we can reduce childhood infections by educating children on infections then we can reduce antibiotic use. If you would like further information on e-Bug please email e-Bug@phe.gov.uk or follow e-Bug on Twitter @eBug_UK
  • Why is Antimicrobial Stewardship Important? - This is a short cartoon video explaining why Antimicrobial Stewardship matters and may be useful for use in presentations or clinical networking events. This video is part of the Mount Sinai Hospital-University Health Network Antimicrobial Stewardship Program with support from CAHO.
  • Massive Open Online Course (MOOC) on Antimicrobial Stewardship available free here.

             Future Learn MOOC on Antimicrobial Stewardship

  • The Reducing Antimicrobial Resistance programme has been designed to support all health and social care staff – both clinical and non-clinical - in a variety of settings to understand the threats posed by antimicrobial resistance, and ways they can help to tackle this major health issue. This programme has been developed by Health Education England in collaboration with Public Health England and NHS England.
    This programme consists of a single e-learning session entitled ‘Reducing Antimicrobial Resistance: An Introduction’. It provides an overview of how to tackle antimicrobial (antibiotic) resistance, key facts about antimicrobial resistance and describes the important role everyone working in a health and social care environment has in tackling it. By the end of this session, health and social care staff will be able to:
              - Discuss why there is such a concern about misuse of antibiotics and antimicrobial resistance
              - List the key risks for development of antimicrobial resistance
              - Identify their role in tackling antimicrobial resistance
  • Provision of social norm feedback to high prescribers of antibiotics in general practice: a pragmatic national randomised controlled trial - This is a report of the research that informed the decision to send CMO letters to the Top 20% antibiotic prescribing GP practices in January 2016.

Chief Medical Officer mailing to GP practices – Jan 2016

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Diagnostics

  • AMR Review: Rapid Diagnostics - Stopping unnecessary use of antibiotics. October 2015.
  • This report provides an overview of how diagnostics can play an important role in the fight against antimicrobial resistance, by reducing unnecessary use. It addresses how we can improve innovation as well as encourage the uptake of diagnostics.
  • Position Paper on Anti-Microbial Resistance Diagnostics – Centre for Evidence-Based Medicine, University of Oxford June 2015. DOI:10.13140/RG.2.1.1135.9846.
    This report highlights the considerable number of new diagnostic technologies in development to underpin the rational prescribing of antibiotics.
  • What a difference a CRP makes. A prospective observational study on how point-of-care C-reactive protein testing influences antibiotic prescription for respiratory tract infections in Swedish primary health care, Scandinavian Journal of Primary Health care, DOI: 10.3109/02813432.2015.1114348
    This study reports the prospective use of CRP point of care testing in Swedish primary care settings for patients with RTIs, and clearly documents the impact on antibiotic prescribing.
  • Tackling Drug-Resistant Infections Globally: Final report and recommendations

Antibiotic Guardian

s300 AntibioticGuardian logo gre

NHS England is a proud supporter of European Antibiotic Awareness Day (EAAD). EAAD is held annually on 18 November as a European-wide event to raise awareness on how to use antibiotics in a responsible way that will help keep them effective for the future. European Antibiotic Awareness Day and Antibiotic Guardian resources can be found here and will be updated to support 2015 activity when available.

Public Health England have commissioned roadshows on Antibiotic Guardianship that aim to deliver guidance, information and resources to health professionals. Resources to engage, promote and share Antibiotic Guardianship within the attendees’ organisation and with their stakeholders will be provided to delegates. The link for registration for these roadshows is here.

Letters to NHS, local authority and professional organisations have been sent by Public Health England, asking organisations to register their EAAD planned activities. Letters can be found here.

Additional information promoting the use of Antibiotic Guardian resources during EAAD events can be found in the accompanying documents below.

   ECDC's Short Video Pledges

   Antibiotic Guardian Bulletin - January 2016

AntibioticGuardian Social Media Resources

In the link below you will find the social media content from Public Health England.

    Social Media Content - Public Health England

 

Out of Hours and Urgent Care

This section will support the development of antibacterial prescribing comparators for use in OOH and urgent care organisations. To share innovation and successful antimicrobial stewardship activities in OOH and urgent care organisations here please contact elizabeth.beech@nhs.net

Bristol CCG CQUIN for community services provider

This is a NHS Bristol CCG CQUIN that was agreed with its community services provider (Bristol Community Health) in 2015/16. Bristol Community Health provides a range of services in the Bristol area (Community Matrons, District Nursing etc.) but notably also an Urgent Care Centre/Walk in Centre. Prescribing by Bristol Community Health is attributed to Bristol CCG, rather than to BCH itself as an independent sector healthcare provider. BCH prescribing therefore affects Bristol CCG’s Quality Premium achievement. Please he CQUIN is attached.

Please direct queries to jon.hayhurst@bristolccg.nhs.uk 

    BCH CQUIN – Quality Premium

TARGET patient information leaflets

The TARGET patient information leaflet has now been adapted for use by OOH and Community Pharmacy providers.

    Treating your infection - out of hours clinics

     Treating your infection - community pharmacies

Community and Out Patient IV Antibiotic Services

This section will link to resources to support the commissioning and use of IV antibiotics in out of hospital locations. To share innovation and successful antimicrobial stewardship activities here please contact elizabeth.beech@nhs.net 

Useful Resources

            CIVAS: Patient Preferences for and Cost Effectiveness of Community Intravenous Antibiotic Services

Key Reports and Links

AMR and AMS Publications

Please find below AMR and AMS publications that you may find useful: 

    • UK National 5 Year Antimicrobial Resistance Strategy 2013-18
    • Annual Progress Report and Implementation Plan 2014 - 
      The 7 key areas for action:
      1. Improving infection prevention and control practices
      2. Optimising prescribing practice
      3. Improving professional education, training and public engagement
      4. Developing new drugs, treatments and diagnostics
      5. Better access to and use of surveillance data
      6. Better identification and prioritisation of AMR research needs
      7. Strengthened international collaboration
    • Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infections: Annual Reports - ARHAI is the expert scientific advisory committee providing independent advice to the Department of Health on antimicrobial resistance and healthcare-associated infection. The committee provides advice on policies and guidance to minimise healthcare-associated infections, and to conserve the effectiveness of antibiotics by encouraging best practice in prescribing.
    • English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) Report 2015 has been published
    • English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) Report 2014 - this reports antimicrobial resistance for drug-bug combinations and antibiotic consumption at a whole health economy level based on an NHS area team footprint using a combined unit of measurement: Defined Daily Dose per 1000 inhabitants per day. Key messages are:
      • The number of patients with bloodstream infections has increased each year from 2010 to 2013
      • There were an increased number of bloodstream infections where antibiotic resistance was identified
      • Antibiotic prescribing has increased in England year on year
      • The majority of antibiotic prescribing takes place in the community (ie general practice)
      • There is considerable variability in both antibiotic resistance and antibiotic prescribing across England; frequently areas with high prescribing also have high resistance
      • Individual healthcare organisations should use this data to benchmark their organisation
    • Review on Antimicrobial Resistance - Responding to mounting international concern about the rise of drug-resistant infections, the UK Prime Minister, The Rt Hon David Cameron MP, commissioned Jim O’Neill in July 2014 to chair this review on antimicrobial resistance. The Review has published Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations which explains why failing to tackle drug-resistant infections will cause 10 million deaths a year and cost up to US $100 trillion by 2050. Comparative Deaths 1
    • National Risk Register for Civil Emergencies 2015 - AMR has been included in the register as an emerging serious long-term issue; pandemic flu is also included in the register.
      The report states that the numbers of infections complicated by AMR are expected to increase markedly over the next 20 years. If a widespread outbreak were to occur, we could expect around 200,000 people to be affected by a bacterial blood infection that could not be treated effectively with existing drugs, and around 80,000 of these people might die. High numbers of deaths could also be expected from other forms of antimicrobial resistant infection.
    • NHS Scotland report: Antimicrobial Use and Resistance in Humans in 2014
    • Position Paper on AMR Diagnostics June 2015 This excellent report, commissioned by the Department of Health,  provides an overview of the diagnostic technologies (including c-reactive protein) that improve the appropriate prescribing of antibiotics, and reports on the evidence base.
    • Tackling Drug-Resistant Infections Globally: Final report and recommendations

Commissioning Resources and Toolkits

This section links to resources to support antimicrobial stewardship activities with commissioning pathways.

Guidelines and Resources

Please find below guidelines and resources that you may find useful: 

TARGET Antibiotics

TARGET Antibiotics is the central resource to help prescribers and commissioning organisations optimise antibiotic prescribing in primary care. It has been developed by the Public Health England (PHE) Primary Care Unit, the Royal College of General Practitioners (RCGP) and the Antimicrobial Stewardship in Primary Care Group.  Some of the resources for commissioners are provided below and an extensive toolkit of materials is available here.

    TARGET Antibiotics Toolkit - Guide to Resources

    Treating your infection

    Treating your infection - community pharmacies

    Treating your infection - out of hours clinics

Public Health England (PHE), the British Society for Antimicrobial Chemotherapy (BSAC), and primary care colleagues have developed seven free TARGET antibiotic webinars highlighting key easy actions you can take to help improve antibiotic prescribing, the patient journey and self-care, reducing future consultations. Professor Cliodna McNulty, Head of PHE Primary Care Unit will lead each session.

Webinars start Wednesday 2 November 1:30 – 2:15 p.m. Full content and reading will be available after each session.

REGISTER NOW for FREE TARGET antibiotic webinar series and gain 7 hours of CPD