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

2. Background (1)  UK 5 year antimicrobial resistance strategy 2013-18  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

3. 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%

4. 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%

5. 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

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

7. 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

8. 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)

10. 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

11. 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)

12. 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

13. 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

14. 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!

15. 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

16. Contact Details  Kiran.hewitt@berkshire.nhs.uk   Jenny.perry@berkshire.nhs.ukJenny.perry@berkshire.nhs.uk  0118 960 5075