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1. Antimicrobial Stewardship Essentials Presentation Title 36pt Arial Bold Sub heading 24pt Arial

2. Content • Statutory obligations for prudent use of antimicrobial prescribing • Prudent antibiotic prescribing: UK initiatives • Local antimicrobial guidelines & prescribing monitoring • National target: Commissioning for Quality and Innovation (CQUIN) – 2d Reduction in antibiotic consumption per 1,000 admissions and proportion of board spectrum antibiotic use

3. National Framework for Infection Control:Code of Practice for Health & Social Care Act 2008 (the “Hygiene Code”) updated 2015 • Code of Practice - statutory obligations Ensureappropriate antibiotic use to optimise patient outcomes and to reduce risk of adverse events and antimicrobial resistance

4. Prudent antibiotic prescribing: a UK initiatives http://antibioticguardian.com/

5. Nathwani et al, 2012 “ Antimicrobial Stewardship”

8. Prescribing tools • Trust Prescribing policy & Treatment guidelines • Smartphone/i-phone: Microguide App by Horizon “Surrey and Sussex NHS Adult Antimicrobial Guidelines/policies” • Version also available on Trust intranet • ‘Start Smart then Focus’

10. Follow local antibiotic prescribing guidance

11. Workspaces

12. MICROGUIDE Web Browser

13. Antimicrobial prescribing do consider the following: • Evidence of infection? Do patients need antibiotics? • Shortest effective course, appropriate dose and route • Allergy status • Consider risk of Antimicrobial resistance and healthcare associated infections e.g. C difficile • Documentation of clinical diagnosis and decisions • Consider microbiological samples and review when available (the presence of bacteria does not necessarily mean there is an infection)

14. Broad spectrum / C.difficile risk antibiotics The “5 Cs” • Cephalosporins • Ciprofloxacin (and other quinolones) • Co-amoxiclav (augmentin) • Clindamycin • Clarithromycin (& other macrolides) “Should be avoided unless there are clear clinical indications for their use”

15. Duration of antibiotics - IV “Treatment with IV antibiotics should not continue beyond 48-72 hours unless recommended by local guideline or microbiologist” “Rationale for continuing IV should be clearly documented with a new review date/duration”

16. Duration of antibiotics - total “Treatment with antibiotics should not continue beyond 7 days (IV and oral) unless recommended by local guideline or microbiologist” Department of Health ARHAI Guidance 2011

17. Penicillin allergy classification • Severe / Life-threatening • Anaphylaxis • Other type 1 hypersensitivity (e.g. angioedema) • Stevens Johnson Syndrome • Non - severe • Mild non type 1 reactions • Mild skin reaction

18. Antimicrobial Stewardship • Antimicrobial prescribing - monitoring • Good Antibiotic Prescribing (GAP) Audits – monthly audits carried out by ward pharmacists • National benchmarking for antimicrobial consumption • Reduction targets introduced 2016/17: • Total antibiotic consumption • AWaRe antibiotics & Carbapenems. For more information click on:https://fingertips.phe.org.uk/profile/amr-local-indicators

19. Good Antibiotic Prescribing (GAP): the care bundle “ all or nothing approach” Compliance was measured using all 6 criteria as below:

20. All 6 care elements must be completed to achieve 100% compliance

21. References/CPD • PHE Antimicrobial Resistance- Resources Handbook, Mar 2017 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/605967/PHE_AMR_resource_handbook.pdf • WHO Antimicrobial Stewardship: competency-based approach (open learning) https://openwho.org/courses/AMR-competency • UK Massive Open Online Course (MOOC) on Antimicrobial Stewardship https://www.futurelearn.com/courses/antimicrobial-stewardship