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Steve McCormick Lead Antimicrobial Pharmacist NHS Lanarkshire

Steve McCormick Lead Antimicrobial Pharmacist NHS Lanarkshire. Antimicrobial use is a National priority. Scottish Antimicrobial Prescribing Group Local Antimicrobial Management Team Healthcare Environment Inspectorate. Definition of antimicrobial stewardship.

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Steve McCormick Lead Antimicrobial Pharmacist NHS Lanarkshire

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  1. Steve McCormick Lead Antimicrobial Pharmacist NHS Lanarkshire

  2. Antimicrobial use is a National priority • Scottish Antimicrobial Prescribing Group • Local Antimicrobial Management Team • Healthcare Environment Inspectorate

  3. Definition of antimicrobial stewardship “Prudent prescribing is not to prescribe as few antibiotics as possible but to identify that small group of patients who really need antibiotic treatment and then explain, reassure and educate the large group of patients who don’t. British Journal of General Practice 2009, 50:567

  4. Stewardship: Prudent Prescribing • Is an antibiotic required? • Only use when clearly indicated, not self limiting (viral) infections • Select appropriateagent from local antimicrobial policy • Minimise collateral damage/risk to patient • Prescribe optimal dosage for shortest duration • Maximise effect but minimise selective pressure • Ask specialist/micro for advice if suspect resistance • Access unedited antibiogram/C+S results

  5. Antimicrobial Prescribing Policies • New empirical Antimicrobial policies for hospitals and primary care in place in all NHS Boards • Evidence based guidance on empirical treatment of common infections now with HAI focus • Promote use of narrow spectrum agents and restrict agents associated with Clostridium difficile.

  6. Risk of C. difficile infection

  7. Amoxicillin Flucloxacillin Phenoxymethylpenicillin Macrolides Tetracyclines Metronidazole Nitrofurantoin Trimethoprim Formulary First line Antibiotics

  8. HPS 2013

  9. Audit of management of commonly encountered infection in primary care Number of consultations by infection

  10. Path of least resistance VT • Dr Gail Haddock, GP NHS Highland • http://youtu.be/m5N3dcPmxW0

  11. SAPG homepage www.scottishmedicines.org.uk/SAPG/Scottish_Antimicrobial_Prescribing_Group__SAPG

  12. Primary Care Antimicrobial Guidelines All NHS boards follow management of infection template from Health Protection Agency

  13. Guidance for acute sore throat

  14. Public Awareness Campaigns

  15. Patient Expectations+++

  16. Booklet shared with parents in UK general practice Francis et al BMJ 2010

  17. Effect of the intervention on patient outcomes Francis et al BMJ 2010

  18. Delayed Scripts • Delay for 48 hours prescription • “Leave behind reception if no better in 2 days” • Evidence to say – do work

  19. Role of the AMT – Primary care • Link in with Primary Care Prescribing Advisers who monitor prescribing using PRISMS • Engage individual prescribers by feeding back meaningful data to promote reflection & discussion in order to influence future prescribing and promote compliance with policy • Improve quality and reduce quantity of antimicrobial prescribing

  20. Role of Individual Prescribers • Awareness of local antimicrobial prescribing policy • Minimise use of non-policy antibiotics and inappropriate dosage or duration • Patient education re self management of self limiting infections to avoid unnecessary use of antibiotics • Especially vigilant on antibiotic use in high risk groups e.g. Elderly, Nursing Homes

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