Antimicrobial Stewardship from Policy to Practice: Experiences from UK Antimicrobial Pharmacists

Infectious Diseases and Therapy

Volumn 4, Issue , 2015, Pages 51-64

  Gilchrist, Mark ^a   Wade, Paul ^b   Ashiru Oredope, Diane ^c   Howard, Philip ^d   Sneddon, Jacqueline ^e   Whitney, Laura ^f   Wickens, Hayley ^g  

^a CHARING CROSS HOSPITAL   (United Kingdom)

^b ST THOMAS HOSPITAL   (United Kingdom)

^c PUBLIC HEALTH ENGLAND   (United Kingdom)

^d LEEDS TEACHING HOSPITALS NHS TRUST   (United Kingdom)

^e HEALTHCARE IMPROVEMENT SCOTLAND   (United Kingdom)

^f ST GEORGE'S UNIVERSITY HOSPITALS NHS FOUNDATION TRUST   (United Kingdom)

^g SOUTHAMPTON GENERAL HOSPITAL   (United Kingdom)

Author keywords

Antibiotic; Antimicrobial stewardship; Healthcare associated infections; Pharmacy; Resistance

Indexed keywords

AMINOPENICILLIN; AMOXICILLIN PLUS CLAVULANIC ACID; CARBAPENEM; CEPHALOSPORIN; CEPHALOSPORIN DERIVATIVE; QUINOLINE DERIVED ANTIINFECTIVE AGENT; QUINOLONE DERIVATIVE;

ANTIMICROBIAL PHARMACIST; ANTIMICROBIAL STEWARDSHIP; ANTIMICROBIAL THERAPY; CLOSTRIDIUM DIFFICILE INFECTION; COMPARATIVE STUDY; DIAGNOSTIC PROCEDURE; GENERAL PRACTICE; HEALTH CARE PERSONNEL; HEALTH PROGRAM; HEALTHCARE ASSOCIATED INFECTION; HOSPITAL INFORMATION SYSTEM; HUMAN; INCIDENCE; INFECTION CONTROL; INFECTION RATE; MEDICAL CARE; MONITORING; OUTCOME ASSESSMENT; PHARMACIST; PRACTICE GUIDELINE; PRESCRIPTION; PRIORITY JOURNAL; QUALITY CONTROL; REVIEW; SOCIAL ATTITUDE; STAPHYLOCOCCUS INFECTION; TRAINING; UNITED KINGDOM; VACCINATION;

EID: 84965010469     PISSN: 21938229     EISSN: 21936382     Source Type: Journal    
DOI: 10.1007/s40121-015-0080-z     Document Type: Review

References (84)

1. Department of Health. Getting ahead of the curve: a strategy for combating infectious diseases (including other aspects of health protection). 2002.
2. Department of Health. Winning ways: working together to reduce healthcare associated infection in England. 2003.
3. National Audit Office. Reducing healthcare associated infections in hospitals in England. 2009.
4. Department of Health. Annual epidemiological commentary: mandatory MRSA, MSSA and E. coli bacteraemia and C. difficile infection data. 2013/14.
5. Department of Health. Bloodborne MRSA infections rates to be halved by 2008. http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/Pressreleases/DH_4093533.
6. Department of Health. The operating framework for the NHS in England 2008/09 http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_081271.pdf.
7. Department of Health. PL CMO (2003) 3: Hospital Pharmacy initiative for promoting prudent use of antibiotics in hospitals. 2003.
8. Wickens HJ, Jacklin A. Impact of the hospital pharmacy Initiative for promoting prudent use of antibiotics in hospitals in England. J Antimicrob Chemother. 2006;58:1230–7.
9. Hand K. Antibiotic pharmacists in the ascendancy. J Antimicrob Chemother. 2007;60(Suppl 1):i73–6.
10. Ansari F, Gray K, Nathwani D, et al. Outcomes of an intervention to improve hospital antibiotic prescribing: interrupted time series with segmented regression analysis. J Antimicrob Chemother. 2003;52:842–8.
11. Wickens HJ, Robson R, Griffiths T. A web-based pharmacy to microbiology referral system. Hosp Pharm. 2006;13:131–2.
12. Weeks C, Jones G, Wylie S. Costs and health care benefits of an antimicrobial management programme. Hosp Pharm. 2006;13:179–82.
13. Talpaert MJ, Rao GG, Cooper BS, Wade PA. Impact of guidelines and enhanced antibiotic stewardship on reducing broad-spectrum antibiotic usage and its effect on incidence of Clostridium difficile infection. J Antimicrob Chemother. 2011;66:2168–74.
14. Thakkar K, Gilchrist M, Dickinson E, Benn J, Franklin BD, Jacklin A, et al. A quality improvement programme to increase compliance with an anti-infective prescribing policy. J Antimicrob Chemother. 2011;66:1916–20.
15. Department of Health. Saving lives—high impact intervention. Care bundle to reduce Clostridium difficile. 2007.
16. Department of Health. Clostridium difficile infection: how to deal with the problem. 2008.
17. Public Health England. Clostridium difficile: what it is, how to prevent, how to treat. 2009.
18. Health Protection Agency. Clostridium difficile infection (CDI): management in care homes. 2010.
19. Department of Health. Clostridium difficile: updated guidance on diagnosis and reporting. 2012.
20. NHS England. Clostridium difficile infection objectives for NHS organisations in 2014/15 and guidance on sanction implementation.
21. NHSScotland Performance. HEAT Targets due for delivery 2006/07–2014/15. http://www.gov.scot/Resource/0046/00467027.pdf.
22. Health Protection Scotland. Commentary of quarterly epidemiological data on Clostridium difficile infection (CDI) and Staphylococcus aureus bacteraemias (SAB) in Scotland. January to March (Q1) 2015. http://www.documents.hps.scot.nhs.uk/hai/sshaip/publications/quarterly-epidemiological-commentaries/2015/2015-q1-sab-cdi-commentary.pdf.
23. Scottish Antimicrobial Prescribing Group. Progress report for 2008–2011. https://www.scottishmedicines.org.uk/files/sapg/SAPG_Progress_Report_2008-11.pdf.
24. Royal College of General Practitioners. TARGET Antibiotics Toolkit [cited 2015 15/07/2015]. http://www.rcgp.org.uk/clinical-and-research/target-antibiotics-toolkit.aspx.
25. Department of Health. Antimicrobial stewardship: Start smart—then focus. 2011.
26. Public Health England. Start smart—then focus: antimicrobial stewardship toolkit for English hospitals. 2015.
27. Department of Health. Annual progress report and implementation plan (2014) of the UK AMR Strategy 2013–18. 2014.
28. Dellit TH, Owens RC, McGowan JE Jr, Gerding DN, Weinstein RA, Burke JP, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44(2):159–77.
29. Dumartin C, Rogues AM, Amadeo B, Pefau M, Venier AG, Parneix P, et al. Antibiotic usage in south-western French hospitals: trends and association with antibiotic stewardship measures. J Antimicrob Chemother. 2011;66(7):1631–7.
30. Fridkin SK, Srinivasan A. Implementing a strategy for monitoring inpatient antimicrobial use among hospitals in the United States. Clin Infect Dis. 2014;58(3):401–6.
31. Chen AW, Khumra S, Eaton V, Kong DC. Snapshot of barriers to and indicators for antimicrobial stewardship in Australian Hospitals. J Pharm Pract Res. 2011;41(1):37–41.
32. NHS Business Services Authority. http://www.nhsbsa.nhs.uk/Index. Accessed Aug 2015.
33. Health and Social Care Information Centre. Prescribing measures, indicators and comparators. 2015. http://www.hscic.gov.uk.
34. Health and Social Care Information Centre. Medicines Optimisation Key Therapeutic Topics Comparators 2015/16. 2015. http://www.hscic.gov.uk.
35. National Institute for Health and Care Excellence. Medicines management options for local implementation. 2015. http://www.nice.org.uk/Media/Default/About/what-we-do/NICE-advice/Key-therapeutic-topics/compiled%20KTT%20Document_final_March%202015%20amend.pdf.
36. Department of Health. ARHAI 5th Annual Report, April 2013–March 2014. 2014. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/405295/ARHAI_annual_report.pdf.
37. Department of Health. Minutes of ARHAI Twenty-Fifth Meeting on 03 July 2014. 2014. https://app.box.com/ARHAI-Minutes-Papers/1/2510541487/21452112235/1.
38. NHS England. Quality Premium: 2015/16 guidance for CCGs. 2015. http://www.england.nhs.uk/wp-content/uploads/2015/04/qual-prem-guid-1516.pdf.
39. NHS PrescQIPP. Antibiotic QP prescribing report for 2014/15 launched. http://www.prescqipp.info/newsfeed/antibiotic-qp-prescribing-report-for-2014/15.
40. NHS National Services Scotland, Scottish Antimicrobial Prescribing Group. Primary Care Prescribing Indicators Annual Report 2013–2014. https://isdscotland.scot.nhs.uk/Health-Topics/Prescribing-and-Medicines/Publications/2014-10-14/2014-10-14-SAPG-Primary-Care-PI-2013-14-Report.pdf?18948000670.
41. Public Health England. English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) Report 2014. http://www.gov.uk/government/uploads/system/uploads/attachment_data/file/362374/ESPAUR_Report_2014__3_.pdf.
42. Howard P, Pulcini C, Levy Hara G, West RM, Gould IM, Harbarth S, et al. An international cross-sectional survey of antimicrobial stewardship programmes in hospitals. J Antimicrob Chemother. 2015;70:1245–55.
43. Howard P, Pulcini C, Levy Hara G, Nathwani D, Gould I. Global antimicrobial stewardship survey—interim analysis of UK data. Oral paper 2087. Birmingham: Federation of Infection Societies; 2013.
44. Rx Info. Define—measure prescribing practices against those of neighbouring hospitals: Rx_Info; 2015 [cited 2015 15/Jul/2015]. http://www.rx-info.co.uk/products/define.ashx.
45. NHS National Services Scotland, Report on Antimicrobial Use and Resistance in Humans in 2013. https://isdscotland.scot.nhs.uk/Health-Topics/Prescribing-and-Medicines/Publications/2015-01-27/2015-01-27-SAPG-2013-Report.pdf?86472719908.
46. Public Health Wales. Reports of the Welsh Antimicrobial Resistance Programme. 2015. https://www.wales.nhs.uk/sites3/page.cfm?orgId=457&pid=28906.
47. Health Social Care Northern Ireland. COMPASS—General Practice prescribing information service. 2015. http://www.hscbusiness.hscni.net/services/2163.htm.
48. Public Health Wales. Antimicrobial Stewardship: “Start Smart—Then Focus”: Guidance for Antimicrobial Stewardship for Hospitals in Wales. 2011. http://www.wales.nhs.uk/sitesplus/documents/888/Public%20Health%20Wales%20Antimicrobial%20Stewardship%20Guidance.pdf.
49. Scottish Antimicrobial Prescribing Group, Quality Improvement. http://www.scottishmedicines.org.uk/SAPG/Quality_Improvement/Quality_Improvement. Accessed Aug 2015.
50. National Institute for Health and Care Excellence. Antimicrobial Stewardship 2015. https://www.nice.org.uk/guidance/indevelopment/gid-antimicrobialstewardship. Accessed Aug 2015.
51. Ashiru-Oredope D, Cookson B, Fry C, on behalf of the Advisory Committee on Antimicrobial R, Healthcare Associated Infection Professional Education S. Developing the first national antimicrobial prescribing and stewardship competences. J Antimicrob Chemother. 2014;69:2886–8.
52. Sneddon J, Gilchrist M, Wickens H. Development of an expert professional curriculum for antimicrobial pharmacists in the UK. J Antimicrob Chemother. 2015;70:1277–80.
53. Wickens H, Farrell S, Jacklin A, Ashiru-Oredope D, Holmes A. Who trains the trainer? Education of antimicrobial pharmacists. Poster 137. Birmingham: Federation of Infection Societies; 2013.
54. Simpson SA, Butler CC, Hood K, Cohen D, Dunstan F, Evans MR, et al. Stemming the Tide of Antibiotic Resistance (STAR): a protocol for a trial of a complex intervention addressing the ‘why’ and ‘how’ of appropriate antibiotic prescribing in general practice. BMC Fam Pract. 2009;10:20.
55. UK Medical Research Council. The STAR Programme (Stemming the tide of antimicrobial resistance) 2005 [cited 2015 15/07/2015]. http://www.stemmingthetide.org/.
56. Butler CC, Simpson SA, Dunstan F, Rollnick S, Cohen D, Gillespie D, et al. Effectiveness of multifaceted educational programme to reduce antibiotic dispensing in primary care: practice based randomised controlled trial. BMJ. 2012;344:d8173.
57. NHS Education for Scotland. Scottish Reduction in Antimicrobial Prescribing (ScRAP) Programme. 2013. http://www.nes.scot.nhs.uk/education-and-training/by-discipline/pharmacy/about-nes-pharmacy/educational-resources/resources-by-topic/infectious-diseases/antibiotics/scottish-reduction-in-antimicrobial-prescribing-(scrap)-programme.aspx.
58. NHS Education for Scotland. Antimicrobial stewardship educational workbook, NHS Education for Scotland. 2015. http://www.nes.scot.nhs.uk/media/3239839/final_antimicrobial_stewardship_workbook.pdf.
59. Wickens HJ, Farrell S, Ashiru-Oredope DA, Jacklin A, Holmes A, In collaboration with the Antimicrobial Stewardship Group of Department of Health Advisory Committee on Antimicrobial Resistance and Health Care Associated Infections (ASG-ARHAI). The increasing role of pharmacists in antimicrobial stewardship in English hospitals. J Antimicrob Chemother. 2013;68(11):2675–81.
60. Jepson A, Wickens H. What does a microbiology pharmacist do? Pharm J. 2003;271:774–5.
61. Knox K, Lawson W, Dean B, Holmes A. Multidisciplinary antimicrobial management and the role of the infectious diseases pharmacist—a UK perspective. J Hosp Infect. 2003;53(2):85–90.
62. Standing Medical Advisory Committee, Sub-Group on Antimicrobial Resistance. The path of least resistance. Department of Health; 1998. http://webarchive.nationalarchives.gov.uk/20080905234748/dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyandguidance/dh_4009357.
63. Ashiru-Oredope D. A survey of primary care antimicrobial pharmacists. Royal Pharmaceutical Socety conference; 2015.
64. Kullar R, Goff DA. Transformation of antimicrobial stewardship programs through technology and informatics. Infect Dis Clin N Am. 2014;28(2):291–300.
65. McGregor JC, Weekes E, Forrest GN, Standiford HC, Perencevich EN, Furuno JP, et al. Impact of a computerized clinical decision support system on reducing inappropriate antimicrobial use: a randomized controlled trial. J Am Med Inform Assoc. 2006;13(4):378–84.
66. Wang HY, Lu CL, Wu MP, Huang MH, Huang YB. Effectiveness of an integrated CPOE decision-supporting system with clinical pharmacist monitoring practice in preventing antibiotic dosing errors. Int J Clin Pharmacol Ther. 2012;50(6):375–82.
67. Sintchenko V, Coiera E, Gilbert GL. Decision support systems for antibiotic prescribing. Curr Opin Infect Dis. 2008;21(6):573–9.
68. Buising KL, Thursky KA, Robertson MB, Black JF, Street AC, Richards MJ, et al. Electronic antibiotic stewardship–reduced consumption of broad-spectrum antibiotics using a computerized antimicrobial approval system in a hospital setting. J Antimicrob Chemother. 2008;62(3):608–16 (65).
69. Baysari MT, Oliver K, Egan B, Li L, Richardson K, Sandaradura I, et al. Audit and feedback of antibiotic use: utilising electronic prescription data. Appl Clin Inform. 2013;4(4):583–95.
70. Audit Commission. A spoonful of sugar: medicines management in NHS hospitals. 2001.
71. Hitchen L. Electronic prescribing needed in hospitals to monitor use of antibiotics. BMJ. 2007;334(7596):712.
72. Curtis C, Marriott J, Langley C. Development of a prescribing indicator for objective quantification of antibiotic usage in secondary care. J Antimicrob Chemother. 2004;54(2):529–33.
73. Jumaa P, Young I, Nightingale P, Clark I. Audit of the antimicrobial treatment of Clostridium difficile toxin-positive episodes using an integrated electronic prescribing, information and communication system. J Hosp Infect. 2009;72(4):371–3.
74. Bignardi GE, Hamson C, Chalmers A. Can we use electronic prescribing to reduce prescription errors for antibiotics? J Infect. 2010;61(5):427–8.
75. Cooley N. Personal communication (via Paul Wade) on benefits of e-prescribing from lead antimicrobial pharmacist. London: Chelsea & Westminster NHS Foundation Trust; 2014.
76. Sheikh A. Personal communication (via Paul Wade) about level of ePrescribing in UK from Professor of Primary Care Research & Development and Chair, eHealth Strategy Group, University of Edinburgh. 2015.
77. Micallef C, Aliyu SH, Santos R, Brown NM, Rosembert D, Enoch DA. Introduction of an antifungal stewardship programme targeting high-cost antifungals at a tertiary hospital in Cambridge, England. J Antimicrob Chemother. 2015;70(6):1908–11.
78. Parkinson C, Gilchrist M, Armstrong-James, D, Whitney L, Bicanic T. Sharing and developing a consensus approach to antifungal stewardship in London— a proof of concept (poster). Harrogate: Federation of Infection Societies; 2014.
79. Chapman ALN, Dixon S, Andrews D, Lillie PJ, Bazaz R, Patchett JD. Clinical efficacy and cost-effectiveness of outpatient parenteral antibiotic therapy (OPAT): a UK perspective. J Antimicrob Chemother. 2009;64(6):1316–24.
80. Gilchrist M, Seaton RA. Outpatient parenteral antimicrobial therapy and antimicrobial stewardship: challenges and checklists. J Antimicrob Chemother. 2015;70(4):965–70.
81. Chapman AL, Seaton RA, Cooper MA, Hedderwick S, Goodall V, Reed C, et al. Good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) in adults in the UK: a consensus statement. J Antimicrob Chemother. 2012;67(5):1053–62.
82. Patel S, Abrahamson E, Goldring S, Green H, Wickens H, Laundy M. Good practice recommendations for paediatric outpatient parenteral antibiotic therapy (p-OPAT) in the UK: a consensus statement. J Antimicrob Chemother. 2015;70(2):360–73.
83. Nathwani D, Sneddon J, Malcolm W, Wiuff C, Patton A, Hurding S, et al. Scottish Antimicrobial Prescribing Group (SAPG): development and impact of the Scottish National Antimicrobial Stewardship Programme. Int J Antimicrob Agents. 2011;38(1):16–26.
84. Social_Services_and_Public_Safety_Northern_Ireland DoH. Antimicrobial Resistance Action Committee (ARAC) [cited 2015 15/07/2015]. http://www.dhsspsni.gov.uk/health_protection-antimicrobial_resisitance.