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Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use [NG15]

Measuring the use of this guidance

Recommendation: 1.1.3

Consider including the following in an antimicrobial stewardship programme: monitoring and evaluating antimicrobial prescribing and how this relates to local resistance patterns providing regular feedback to individual prescribers in all care settings about: - their antimicrobial prescribing, for example, by using professional regulatory numbers for prescribing as well as prescriber (cost centre) codes - patient safety incidents related to antimicrobial use, including hospital admissions for potentially avoidable life‑threatening infections, infections with Clostridium difficile or adverse drug reactions such as anaphylaxis providing education and training to health and social care practitioners about antimicrobial stewardship and antimicrobial resistance integrating audit into existing quality improvement programmes.

What was measured: Proportion of antimicrobial stewardship programmes that provide regular reports on antimicrobial use by department provided to prescribers.
Data collection end: October 2017
60%
Number that met the criteria: 89 / 148
Area covered: England
Source: Scobie, A., Budd, E. L., Harris, R. J. et al. (2019) Antimicrobial stewardship: an evaluation of structure and process and their association with antimicrobial prescribing in NHS hospitals in England. The Journal of antimicrobial chemotherapy 74(4): 1143-1152

What was measured: Proportion of antimicrobial stewardship programmes that provide regular distribution of antimicrobial resistance surveillance data report to prescribers.
Data collection end: October 2017
31%
Number that met the criteria: 46 / 148
Area covered: England
Source: Scobie, A., Budd, E. L., Harris, R. J. et al. (2019) Antimicrobial stewardship: an evaluation of structure and process and their association with antimicrobial prescribing in NHS hospitals in England. The Journal of antimicrobial chemotherapy 74(4): 1143-1152

What was measured: Proportion of antimicrobial stewardship programmes that provide mandatory education on antimicrobial prescribing to all clinicians and relevant staff.
Data collection end: October 2017
49%
Number that met the criteria: 72 / 148
Area covered: England
Source: Scobie, A., Budd, E. L., Harris, R. J. et al. (2019) Antimicrobial stewardship: an evaluation of structure and process and their association with antimicrobial prescribing in NHS hospitals in England. The Journal of antimicrobial chemotherapy 74(4): 1143-1152

What was measured: Proportion of antimicrobial stewardship programmes that provide mandatory education on antimicrobial prescribing to junior doctors.
Data collection end: October 2017
86%
Number that met the criteria: 128 / 148
Area covered: England
Source: Scobie, A., Budd, E. L., Harris, R. J. et al. (2019) Antimicrobial stewardship: an evaluation of structure and process and their association with antimicrobial prescribing in NHS hospitals in England. The Journal of antimicrobial chemotherapy 74(4): 1143-1152


Recommendation: 1.1.4

Ensure that roles, responsibilities and accountabilities are clearly defined within an antimicrobial stewardship programme.

What was measured: Proportion of antimicrobial stewardship programmes that had a Lead Clinician or Medical Director responsible for programme outcomes.
Data collection end: October 2017
82.4%
Number that met the criteria: 122 / 148
Area covered: England
Source: Scobie, A., Budd, E. L., Harris, R. J. et al. (2019) Antimicrobial stewardship: an evaluation of structure and process and their association with antimicrobial prescribing in NHS hospitals in England. The Journal of antimicrobial chemotherapy 74(4): 1143-1152

What was measured: Proportion of antimicrobial stewardship programmes that had a Lead Antimicrobial Pharmacist responsible for antimicrobial use.
Data collection end: October 2017
99%
Number that met the criteria: 146 / 148
Area covered: England
Source: Scobie, A., Budd, E. L., Harris, R. J. et al. (2019) Antimicrobial stewardship: an evaluation of structure and process and their association with antimicrobial prescribing in NHS hospitals in England. The Journal of antimicrobial chemotherapy 74(4): 1143-1152


Recommendation: 1.1.8

Organisations establishing antimicrobial stewardship teams should ensure that the team has core members (including an antimicrobial pharmacist and a medical microbiologist) and can co-opt additional members depending on the care setting and the antimicrobial issue being considered.

What was measured: Proportion of antimicrobial stewardship teams that included an antimicrobial Pharmacist and Clinical Microbiologist/Infectious Diseases specialist as core members.
Data collection end: October 2017
93%
Number that met the criteria: 137 / 148
Area covered: England
Source: Scobie, A., Budd, E. L., Harris, R. J. et al. (2019) Antimicrobial stewardship: an evaluation of structure and process and their association with antimicrobial prescribing in NHS hospitals in England. The Journal of antimicrobial chemotherapy 74(4): 1143-1152


Recommendation: 1.1.26

When prescribing any antimicrobial, undertake a clinical assessment and document the clinical diagnosis (including symptoms) in the patient's record and clinical management plan.

What was measured: Proportion of antimicrobial stewardship teams whose prescribers were required to document dose, duration and indication for all antimicrobial prescriptions.
Data collection end: October 2017
97%
Number that met the criteria: 144 / 148
Area covered: England
Source: Scobie, A., Budd, E. L., Harris, R. J. et al. (2019) Antimicrobial stewardship: an evaluation of structure and process and their association with antimicrobial prescribing in NHS hospitals in England. The Journal of antimicrobial chemotherapy 74(4): 1143-1152


Recommendation: 1.1.38

Use an intravenous antimicrobial from the agreed local formulary and in line with local (where available) or national guidelines for a patient who needs an empirical intravenous antimicrobial for a suspected infection but has no confirmed diagnosis.

What was measured: Proportion of people with severe community-acquired pneumonia who commenced on antibiotics consistent with the study hospital’s antibiotic prescribing guidelines.
Data collection end: February 2017
70%
Number that met the criteria: 7 / 10
Area covered: Local
Source: Powell N, McGraw-Allen K, Menzies A, Peet B, Simmonds C, and Wild A. (2018). Identifying antibiotic stewardship interventions to meet the NHS England CQUIN: An evaluation of antibiotic prescribing against published evidence-based antibiotic audit tools. Clinical Medicine, and Journal of the Royal College of Physicians of London, 18(4), pp.276-281.


Recommendation: 1.1.39

Consider reviewing intravenous antimicrobial prescriptions at 48–72 hours in all health and care settings (including community and outpatient services). Include response to treatment and microbiological results in any review, to determine if the antimicrobial needs to be continued and, if so, whether it can be switched to an oral antimicrobial.

What was measured: Proportion of people with severe community-acquired pneumonia who were prescribed IV antibiotics whose prescription was reviewed within 72 hours.
Data collection end: February 2017
100%
Number that met the criteria: 10 / 10
Area covered: Local
Source: Powell N, McGraw-Allen K, Menzies A, Peet B, Simmonds C, and Wild A. (2018). Identifying antibiotic stewardship interventions to meet the NHS England CQUIN: An evaluation of antibiotic prescribing against published evidence-based antibiotic audit tools. Clinical Medicine, and Journal of the Royal College of Physicians of London, 18(4), pp.276-281.

What was measured: Proportion of antimicrobial stewardship programmes that have a formal procedure for all clinicians to review appropriateness of antimicrobials 48 to 72 h after initial order.
Data collection end: October 2017
71%
Number that met the criteria: 105 / 148
Area covered: England
Source: Scobie, A., Budd, E. L., Harris, R. J. et al. (2019) Antimicrobial stewardship: an evaluation of structure and process and their association with antimicrobial prescribing in NHS hospitals in England. The Journal of antimicrobial chemotherapy 74(4): 1143-1152



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