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PCQS – Antibiotic targets
All practices, as part of PCQS, are asked to find ways to support the Antimicrobial Resistance (AMR) agenda and Antimicrobial stewardship.
Prescribers are asked to appropriately use antibiotics and reduce their broadspectrum antibiotics (cephalosporins, quinolones and co-amoxiclav) by 10% or more.
The information below should provide support for prescribers support in achieving these targets.
Ideas to support you to achieve your targets
- 1. Identify an Antimicrobial Steward within your practice
This person will lead on training others and identifying ways in which your practice can improve their antibiotic prescribing. A mentor to support others within the practice, the Antimicrobial Steward will support the AMR agenda and ensure your practice is on track!
- 2. Antibiotic Action Plans
Has your practice got an antibiotic action plan? Use this to plan any meetings for peer review and to identify work to be undertaken. Ask any trainee doctors to use the topic of antibiotics for research. Actions plans should be reviewed every quarter and submitted to Medicines Management every 6 months.
- 3. Follow your local Formulary advice
Support prescribers to use local recommendations and strategies to reduce inappropriate antibiotic prescribing. Ensure the latest Wirral Antimicrobial Guidelines are being used by all prescribers.
Medicines Management can import EMIS web audits into your clinical system for you to run on a monthly basis. These reports will look at all antibiotic volume and broadspectrum volume/choice. The results of the audits could be discussed at clinical meetings or be used for peer or self-reflection.
Medicines Management can set up an EMIS web Protocol for prescribers. This can be tailored to suit individual practice needs. The aim of the protocol is to encourage prescribers to consider if a broadspectrum antibiotic is required and provide reasons for choice. Some practices have found this particularly helpful if they have locum GPs working in their practice.
Use the BI portal for information regarding antibiotic prescribing.
There is so much information available to prescribers on the TARGET website. Choose from patient information leaflets, to audit resources or e-learning. The Treat Your Infection Leaflet can be embedded into your clinical system, supporting you with prescribing decisions and providing excellent information to your patients. Please ask a member of the Medicines Management Team.
- 8. Patient information materials
- 9. European Antibiotic Awareness Day and World Antibiotic Awareness Week
- 10. Keep Antibiotics Working Public Campaign
Public Health England (PHE) has launched a new campaign to help tackle antibiotic resistance. Keep Antibiotics Working highlights that taking antibiotics when you do not need them puts you and your family at risk and to always ask your doctor or nurse for advice. Practices should have received their GP surgery packs a couple of weeks ago. If you have not received these packs please contact WICCG.PrimaryCareComms@nhs.net.
The campaign has produced a new animated TV advert and social media, local pharmacies, GP surgeries and local authorities will be supporting it.
Delayed antibiotic (or back up) prescribing is a proven technique for reducing unnecessary antibiotic prescribing. Prescribers can use this approach when there is clinical uncertainty about whether a condition is self-limiting or is likely to deteriorate. There is a NICE Quality Standard which provides information regarding this technique and about the methods that can be used for evaluation.
A back-up (delayed) prescription is a prescription (which may or may not be post-dated) given to a patient or carer, with the assumption that it will not be dispensed immediately, but in a few days if symptoms worsen. It may also be left at an agreed location (for example, the local pharmacy) to be collected at a later date.
Always use a suitable READ code – such as “Deferred antibiotic therapy” 8BP0.
Remember only use this technique where needed – if you are confident that an antibiotic is not required then do not prescribe. Evidence shows that time taken educating patients that an antibiotic is not required will reduce future consultations.
- 13. Peer review at Prescribing cluster group
As part of PCQS, prescribers are asked to attend prescribing cluster groups to feedback about any antibiotic work that has been undertaken in their practice. Please use this opportunity to discover what has worked well for others and what techniques haven’t been successful. These ideas could be implemented in your own practice in the future. It is expected that the March 2018 cluster groups will be reserved for this purpose (dates to be arranged).
- 14. Pledge to be an Antibiotic Guardian
Ask all practice staff to pledge to be an Antibiotic Guardian by visiting the antibiotic guardian website.
Submission of PCQS evidence
Evidence for PCQS should be submitted to the Medicines Management Team through the Prescribing Adviser email address - mlcsu.prescribingadviserswirral@nhs.net.
Where possible please send electronic evidence.
Clostridium difficile – Wirral Infection Prevention & Control Service
There were 3 reported cases of community attributed Clostridium difficile infection in October 2017. The key learning points from these reviews were:
Loperamide should not be prescribed when C difficile infection is suspected as a cause for diarrhoea
Areas of good practice identified from the three October reviews were as follows:
- Prompt stool sampling
- Antibiotics stepped down appropriately and in a timely manner
- Clinical specimens were obtained
- Practices liaised with the IPC Service and WUTH Microbiologist
C difficile rates per 100,000 for Wirral continue to be higher than both North West and England:
Fosfomycin (oral) Shared Care Agreement: Reminder
The RAG status of fosfomycin changed from RED to AMBER earlier this year. It is approved for ESBL and CPE UTIs.
There is a UK licensed oral fosfomycin preparation (Monuril 3 g granules for oral solution) for the treatment of acute lower uncomplicated urinary tract infections, caused by pathogens sensitive to fosfomycin in adult and adolescent females.
Fosfomycin (oral) is also used to treat uncomplicated UTI in men which is an unlicensed indication. GPs will only be asked to prescribe oral fosfomycin on Medical Microbiologist recommendation. A shared care guideline to support GPs in prescribing is available.
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