When it comes to implementing toolkits for antimicrobial stewardship (AMS), hospitals are doing better than primary care, according to research by Public Health England (PHE), presented at the Royal Pharmaceutical Society conference on 14 September 2015.
The implementation of the toolkits — clinical guidance that helps healthcare professionals use antibiotics appropriately — is now part of the NHS code of practice and supports the AMS guideline from the National Institute for Health and Care Excellence (NICE).
PHE sent an online survey assessing the use of its toolkits — one for primary care and one for secondary care — to 146 acute NHS trusts and 211 clinical commissioning groups (CCGs), as part of an assessment to work out baseline AMS activity during NHS England’s five-year antimicrobial resistance strategy. PHE states that 68% of acute NHS trusts and 41% of CCGs participated. Of 99 acute NHS Trusts that completed the survey, 86% had reviewed the ‘start smart then focus’ antimicrobial stewardship (SSTF) toolkit, designed for secondary care, and 48% had developed an action plan to implement it. In comparison, 70% of 86 CCGs had reviewed the ‘TARGET’ antimicrobial stewardship toolkit for primary care and only 13% had developed an action plan for implementation.
“We do need further work, particularly in primary care,” said Diane Ashiru-Oredope, the pharmacist lead for antimicrobial resistance and stewardship at PHE, who presented the results.
The responses to the survey revealed that 84% of acute trusts had a dedicated AMS committee focused on reviewing antimicrobial use, but in CCGs this figure fell to 18%. However, for 11% of CCGs this function was performed by an infection prevention and control committee and for 21% by a drugs and therapeutics committee. “This is great, because we want AMS embedded more broadly in healthcare. But more research is needed to know if these committees will dedicate as much time to AMS as a dedicated committee,” said Ashiru-Oredope.
Furthermore, a far higher proportion of acute trusts had carried out audits of antibiotic use to find out if the SSTF toolkit was being adhered to, compared with CCGs and the TARGET toolkit.
And more acute trusts had dedicated education and training resources focused on antibiotic use, although overall these figures were low in both primary and secondary care. “There’s a lot of work we need to do around education and training,” she said.
The use of antimicrobial pharmacists also differed between acute NHS trusts and CCGs. A specialist antimicrobial pharmacist was employed in 90% of acute trusts compared with only 5% in CCGs. However, in 66% of CCGs, the AMS strategy was led by a prescribing adviser or medicines management pharmacist. “The role of antimicrobial pharmacists in primary care is still developing,” said Ashiru-Oredope.
For patients, PHE has also introduced a self-care guide to help them treat their infection. The same guide has been adapted for use in GP surgeries and community pharmacies. “We’re trying to support patients to self-care and to support the relationship between GPs and pharmacists by making sure they are both saying the same things to patients,” she said.
The next step is to embed AMS in the whole healthcare model, Ashiru-Oredope said. “We don’t want it to just be the remit of specialists, we want it to be part of everyone’s role,” she added. “All doctors, all the pharmacists and the nurses and all other healthcare professionals.”