local actions to tackle antimicrobial resistance
TRANSCRIPT
Local actions to tackle antimicrobial resistance (AMR)
Faculty of Public Health Conference15 June 2016
Dr Diane Ashiru-OredopePharmacist Lead; Antimicrobial Resistance ProgrammePublic Health EnglandTwitter - @DrDianeAshiru #AntibioticGuardian
Ms Thara Raj
Antimicrobial ResistanceA major threat to future healthcare -
clinical, public health and economic implications
Antimicrobial use is a recognised driver
Clinically (all conditions) - appropriate prescribing improves patient outcomes
2
The future if we do not act now
3
By 2050: more deaths from resistant infections compared to e.g. cancer
http://amr-review.org/
Antimicrobial Resistance Dr Diane Ashiru-Oredope
Non-susceptibility (%) among (a) E. coli, (b) Klebsiella spp. and (c) Enterobacter spp. from bacteraemias in England, Wales and Northern Ireland, as reported to PHE-LabBase.
Livermore D M et al. J. Antimicrob. Chemother. 2013;jac.dkt212
© The Author 2013. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: [email protected]
Cephalosporins, diamonds; ciprofloxacin, squares; gentamicin, triangles Antimicrobial Use
is a driver for resistance
AMR: individual riskRisk of resistance persists for at least 12 months in
individuals after each intake of an antibiotic
Increased risk of resistant organism
Antibiotic in past 2 months
Antibiotic in past 12 months
UTI 5 studies: n = 14,348 2.5 times 1.33 times
RTI7 studies: n = 2,605 2.4 times 2.4 times
A meta analysis of English Primary CareCostello et al. BMJ. (2010) 340:c2096.
5 Antimicrobial Resistance Dr Diane Ashiru-Oredope 5
Tackling AMR:
• The government
• Professional bodies/organisations/Public health agencies and leads
• Healthcare professionals – human and animal health
• The public
• Pharmaceutical companies
Antimicrobial Resistance Dr Diane Ashiru-Oredope 6 AMR; WLMHT Physical Health Conference Dr Diane Ashiru-Oredope
EVERYONE HAS A ROLE:
6
Global action on AMR
7
World Health Assembly 2014 resolution Global Health Security Agenda: AMR action package - mechanism and collaboration to accelerate implementation
WHO Global AMR Action Plan 2015 – framework for action
Antimicrobial Resistance Dr Diane Ashiru-Oredope
UK 5-year AMR Strategy 2013-18: Seven key areas for action
PHEHuman health
DH – High Level Steering Group (cross government)
DefraAnimal health
DH
1. Improving infection prevention and control2. Optimising prescribing practice3. Improving professional education, training
and public engagement 4. Better access to and use of surveillance
data
• Improving the evidence base through research
• Developing new drugs, vaccines and other diagnostics and treatments
• Strengthening UK and international collaboration
Impact of EAAD and Antibiotic Guardian Dr Diane Ashiru-Oredope & Ms Katerina (Aikaterini) Chaintarli EAAD and Antibiotic Guardian Dr Diane Ashiru-Oredope
Antimicrobial Resistance Dr Diane Ashiru-Oredope 8
9
Antimicrobial Stewardship Tools NHSI_PHE
#AMSWorkshop Dr Diane Ashiru-Oredope
What tools are available:
10 Antimicrobial Stewardship Tools NHSI_PHE #AMSWorkshop Dr Diane Ashiru-Oredope
Antimicrobial stewardship toolkits: PHE in collaboration with several professionals and professional organisations
Antimicrobial Stewardship Tools NHSI_PHE #AMSWorkshop Dr Diane Ashiru-Oredope 11
Treating your infection
Never share antibiotics and always return any unused antibiotics to a pharmacy for safe disposal
TARGET LEAFLET – GP, OOH, Community Pharmacy
TREATING YOUR INFECTION LEAFLET: GPs; Out of Hours practice; Community Pharmacy• A leaflet for health professionals working in primary care to use when provide
advice to patients. The leaflet provides practical advice on how to treat symptoms of common self limiting infections and warning signs for serious illness.
Developed by Public Health England 12
E-Learning for Healthcare (HEE)
Antimicrobial Stewardship Tools NHSI_PHE #AMSWorkshop Dr Diane Ashiru-OredopeAMR; WLMHT Physical Health Conference Dr Diane Ashiru-Oredope
Free for all with NHS email address
13
Open access for ALL
Antimicrobial Stewardship Tools NHSI_PHE #AMSWorkshop Dr Diane Ashiru-Oredope
Local Action to tackle antimicrobial resistance (AMR) using evidence and knowledge of seasonal peaks in demand
Seasonal prescribing patterns
15 AMR Local Indicator
Source: BBC News website 18.11.2015
How to effect change at a local level• Local ownership
• Antimicrobial stewardship
• Rigorous scrutiny and use of local indicators
• Financial incentives- quality premiums
• Leadership and innovation
• Demand management - engaging the public - tackling communicable diseases
16 Antimicrobial Stewardship Tools NHSI_PHE #AMSWorkshop Dr Diane Ashiru-Oredope
PHE Fingertips Web Portal - Information for local action(http://fingertips.phe.org.uk/)
17 Antimicrobial Resistance Dr Diane Ashiru-Oredope
PHE Fingertips Web Portal
18 Antimicrobial Resistance Dr Diane Ashiru-Oredope
Published 5 April 2016
19 Antimicrobial Stewardship Tools NHSI_PHE #AMSWorkshop Dr Diane Ashiru-Oredope
Domain Quality IndicatorsAMR • % of E. coli from blood tested for susceptibility to carbapenems
• Gram-negative BSIs and resistance to key antibiotics
Prescribing • Community prescribing (CCG)
HCAI • Mandatory bacteraemia surveillance data• Mandatory CDI surveillance data• Mandatory SSI surveillance data
IPC • ERIC data on single rooms/single rooms with ensuite (by Trust);• PLACE cleanliness scores• Healthcare worker influenza vaccination
AMS • Antibiotic Guardians per 100,000 population per year (CCG)• SSTF review and action plans (by Trust);
20 Antimicrobial Resistance Dr Diane Ashiru-Oredope
Examples of Local antimicrobial stewardship groups
Outer North East London AMR Stewardship
Group using NICE baseline assessment tool
to benchmark progress
Expanding to include inner North East
London
21 Antimicrobial Stewardship Tools NHSI_PHE #AMSWorkshop Dr Diane Ashiru-Oredope
Southwark - method• Used audit tools to help local practices review
their overall volume of antibiotic prescribing and prescribing of broad spectrum antibiotics against local antibiotic guidelines.
• Focused reviews in a number of practices who were significant outliers in prescribing broad spectrum antibiotics.
22 Antimicrobial Stewardship Tools NHSI_PHE #AMSWorkshop Dr Diane Ashiru-Oredope
Southwark - results
23 Antimicrobial Stewardship Tools NHSI_PHE #AMSWorkshop Dr Diane Ashiru-Oredope
A reduction of almost 2% based on the 14/15 baseline
Quality Premium Indicator
Indicator unit of measurement
Baseline value 2014/15
Value for 2015/16 by quarter
Q1 Q2 Q3 Q4 Average
Broad spectrum antibiotics
% Items(Target set by NHSE ≤11.5%)
12.8
13.35
12.08
9.21
8.84
10.8
Newham - method• Launched a prescribing quality improvement scheme
• Developed local primary care antibiotic guidelines with neighbouring CCGs
• Visits to each practice to discuss prescribing data and outliers followed up
• Two education events
• Used RCGP accredited education materials/PHE TARGET toolkit
• Practices linked up with hospital microbiologists to address clinical queries
24 Antimicrobial Stewardship Tools NHSI_PHE #AMSWorkshop Dr Diane Ashiru-Oredope
Newham - results
25 Antimicrobial Stewardship Tools NHSI_PHE #AMSWorkshop Dr Diane Ashiru-Oredope
Quality premium indicators Target values CCG values (April 15 to Feb 16)
Number of antibiotics prescribed in primary care by 1% (or greater) from each CCG’s 2013/14 value
1.063 1.0
Number of co-amoxiclav, cephlosporins and quinolones as a percentage of the total number of selected antibiotics prescribed in primary care by 10% from each CCG’s 2013/14 value, or to be below the 2013/14 median proportion for English CCGs (11.3%)
14.05 10.03
Nurse leadership in a GP practice
“..when you are faced with an anxious or demanding patient in your clinic there is still pressure to prescribe”
Liz Cross, Practice Nurse, Attenborough GP Practice
26 Antimicrobial Stewardship Tools NHSI_PHE #AMSWorkshop Dr Diane Ashiru-Oredope
27 Antimicrobial Stewardship Tools NHSI_PHE #AMSWorkshop Dr Diane Ashiru-Oredope
“Everyone was followed up after 28 days and the numbers of patients who came back for a follow up appointment
halved and this was during the winter months”Liz Cross
Engaging with patients & the public
Developed by Public Health England
18th November
Awareness & engagement campaigns
EAAD (18th November) is an international collaboration with World Antibiotic Awareness Week and awareness weeks in
USA, Canada & Australia (16-22 November)
Australia Antibiotic Awareness Week
USA Get Smart without Antibiotics
Canada Antibiotic Awareness week
AMR: #AntibioticGuardian Roadshow Dr Diane Ashiru-Oredope Antimicrobial Stewardship Dr Diane Ashiru-OredopeImpact of EAAD and Antibiotic Guardian Dr Diane Ashiru-Oredope & Ms Katerina (Aikaterini) Chaintarli EAAD and Antibiotic Guardian Dr Diane Ashiru-Oredope 30 AMR: #AntibioticGuardian Roadshow Dr Diane Ashiru-Oredope
Educating the public: the value of awareness campaigns
Dr Diane Ashiru-Oredope31
Local Actions on public and healthcare professional awareness and engagement
Public Engagement – Devon County Council, Parents & Children’s centre
Educating the public: the value of awareness campaigns Dr Diane Ashiru-Oredope
The Listen to Your Gut campaign has been developed for parents by parents in conjunction with Devon County Council’s Public Health Team and My Start
Children’s Centre in Ilfracombe, which is run by Action for Children
33 Antimicrobial Stewardship Dr Diane Ashiru-Oredope 33
EAAD & Antibiotic Guardian: children centres; hospitals; community pharmacies
University College London Hospitals
Awareness and engagement in Hospitals, community pharmacies, universities, organisations in all UK Countries
Educating the public: the value of awareness campaigns Dr Diane Ashiru-Oredope 34Educating the public: the value of awareness campaigns Dr Diane Ashiru-Oredope
Engagement via social media – e.g pictures tweeted with #AntibioticGuardian
Educating the public: the value of awareness campaigns Dr Diane Ashiru-Oredope 35Educating the public: the value of awareness campaigns Dr Diane Ashiru-Oredope
Antimicrobial Resistance Dr Diane Ashiru-Oredope
You are invited to become an Antibiotic Guardian today (available via mobiles)
36 Antimicrobial Resistance Dr Diane Ashiru-Oredope
Future: Sustainability and Transformation Plans (STPs)
To deliver plans that are based on the needs of local populations, local health and care systems came together in January 2016 to form 44 STP ‘footprints’.
To produce a multi-year Sustainability and Transformation Plan (STP) showing how together they will improve services
STPs are a key element on the NHS Shared Planning Guidance and the local implementation of the Five Year Forward View
37 Antimicrobial Resistance Dr Diane Ashiru-Oredope
Acknowledgements
38 Antimicrobial Resistance Dr Diane Ashiru-Oredope