Improving Safety & Quality of Antimicrobial Prescribing in Berkshire HFT Kiran Hewitt, Lead Clinical Pharmacist (Project Lead) Jenny Perry, Senior Pharmacist (Project Manager)

Background (1)  UK 5 year antimicrobial resistance strategy  7 key areas for action, including optimising prescribing practice, improving IC, improving education and training  ESPAUR  PMs commission on ABR by the Wellcome Trust  EAAD 18 th November

Background (2) Between 2010 and 2013:  Antibiotic use  by 6%  general practice prescribing  by 4%  prescribing to hospital inpatients  by 12%  other community prescriptions (dentists, out of hours prescribers, nurses, NMPs)  by 32%

Audit Standards & Results Criteria Audit Criteria – Standards = 100% Findings 1 Relevant cultures will be taken before antimicrobial therapy is started 49% 2 Drug allergies (antimicrobials) will be noted on the chart 74% 3 Route of administration will be indicated on the chart 98% 4 Dose and frequency will be indicated on the chart 97% 5 The antimicrobial start date will be noted on the chart 85% 6 The duration will be noted on the drug chart 77% 7 Indication will be noted on the chart 47% 8Treatment will be in line with trust guidelines83%

Aims Leadership role (pharmacist) to drive stewardship across the Trust Better access to guidelines – to support remote working Training and better education of prescribers - main focus of action plan and internal self assessment Use of technology to enhance the deliver of these Networking and regional collaboration with subject experts – Membership of TVWAPN (sub group of Chief Pharmacists group) Guidelines review in collaboration with both local hospitals PSF bid April 2014

Developments (1) Recruitment of Project Manager Sept-14 Purchase, training and development of Microguide smartphone app – Sept to Nov-14 Key Benefits:

Developments (2) Initial Promotion – EAAD launch Face to face intro for all ward staff – Presentation of audit findings, App demo, posters, Start Smart Then Focus reminder cards

Developments (3) Trust-wide Publicity: – Annual Quality Improvement Event – first prize winner (Nov-14) – IC Link Practitioners annual study day (Nov-14) – Trust Best Practice and Innovation Event (Feb-15)

Developments (4) E-learning package introduction Original plan – regional module to utilise local and regional expertise = best option Delayed launch – Options appraisal for alternatives – Bespoke Trust package developed – Feb-15

Essential training requirement agreed – for medical and nursing staff groups, pharmacy – Managed through L&D User group feedback prior to launch Added to medical trainee induction “Start Smart Then Focus” and App posters on wards GP and Out of Hours GP presentation – May-15 Successes (1)

Targetted training for GPs PDSA 3 e-learning module formally implemented PDSA 5 Targetting S1 on WBCH PDSA 4 Three training sessions for all ward staff on WBCH PDSA 1a) Training roll out on Rose ward PDSA 1b) Display StartSmart Poster PDSA 2

Nationally - NICE Guidelines NG15 – AMS: systems and processes for effective antimicrobial medicine use – August 2015 Baseline audit of compliance = 41% – Establish key areas of improvement formal approval of AMS programme AM team development AM Pharmacist Better communication across care settings Robust documentation of Rx decisions

Challenges Trust wide roll out – Oct-15 for all CHS wards, Dec-15 for MH Audit of other non-inpatient areas? Improvements over time – sustainability? Champion/lead needed E-learning for local GPs and sharing with others CCG engagement for primary care – Regional group membership already established (TV&WAPN) – – MUS conference Work with local acute trusts – Own agenda – Internal influence and Board approval – Expanding boundaries in the East Sharing our “package” with the TV&W group – Already the experts!

Lessons Learnt What would we have achieved without PSF support? A lot can be achieved with commitment Sufficient project management time is essential. QI experience important. Does it make a difference to patient care? – yes Future area for research Applicable to all – yes

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