1. Antibiotic Prescribing Dr Darah Burke GP Awburn House

2. Background “Antibiotics resistance 'as big a risk as terrorism' - medical chief” Prof Dame Sally Davies 2013 Over prescribing of antibiotics leads to resistance C Diff and MRSA on the rise

3. Where we were Several Years Highest Prescribers of total antibiotics in CCG As of January 2015 Astro/StarPUAwburn House1.34 National 1.187 CCG1.156 8 th Highest Prescribers of Cephalosporins/Quinolones/Co-amoxiclav

4. Why? Culture? Open Surgeries? – which can lead to long waits for patients Telephone prescribing to avoid load on open surgeries? Excuses?

5. What we had tried Patient leaflets Deferred prescriptions Posters, advertising ALL FAILED

6. Time to bite the bullet March 2015 Visit from Saarah Niazi-Ali (antibiotic specialist pharmacist) and Hannah (prescribing technician) Audit of Co-amoxiclav

7. 50 patients who were prescribed Co-Amoxiclav in last 4 months In 74% of cases, antibiotics were inappropriate CCG Guidelines – Co-amoxiclav only to be used for Human or animal bite Diverticulitis Facial cellulitis Acute pyelonephritis There were NO occasions when any of these indications were documented

8. What we did next Stop prescribing Co-amoxiclav except for indications Nominated GP to undertake self-assessment ALL clinicians to undertake e-learning modules“Antibiotic resistance in primary care” “Managing Acute RTIs” Both RCGP and FREE! ALL clinicans to review guidelines RE-AUDIT, RE-AUDIT, RE-AUDIT

9. What we did FURTHER WHOLE TEAM CULTURE CHANGE RECEPTIONISTS, PRACTICE NURSE PATIENTS DO NOT PRESCRIBE – WE DO WEEKLY AUDITS

10. AUDITS 2 weeks before and after Before VisitAfter Visit Patients prescribed Co- Amoxiclav 101 Patients prescribed Amoxicillin 6440

11. AUDITS Week CommencingPrescriptions for Amoxicillin Prescriptions for Co-amoxiclav 11.5.15181 18.5.15192 25.5.15252 1.6.15131 8.6.15120 15.6.15141 22.6.15262 29.6.15152 6.7.15213 21.9.15143 28.9.15171 12.10.15193 26.10.15180 2.11.15220

12. Run Chart 1 st Visit to do audit Met with all clinicians to feedback

13. Recent Position 1 st qtr 14/15 vs 15/16

14. Click to rank within/outside local clustering Recent Position 2 nd qtr 14/15 vs 15/16

15. Click to rank within/outside local clustering Recent Position 3 rd qtr 14/15 vs 15/16

16. Conclusions Total antibiotic prescribing has reduced We are no longer the highest, but neither are we the lowest No C Diff for a year Was this about antibiotics anyway?

17. Conclusions TEAMWORK OPENNESS AND HONESTY WILLINGNESS TO CHANGE REFLECTING ON PERFORMANCE MONITORING PERFORMANCE CELEBRATING SUCCESS