Quality statement 2: Prescribing antimicrobials
Adults first presenting with suspected acute respiratory infection are not routinely prescribed antimicrobials based only on remote assessment.
Wherever possible it is important to carry out a face-to-face assessment of severity of illness and risk to inform decisions about care and treatment before prescribing antimicrobials. This may support diagnostic accuracy and will support antimicrobial stewardship and appropriate escalation of care, when needed. Sometimes there may be a sound reason to prescribe remotely such as if the person cannot attend face-to-face or the severity of illness can be adequately assessed remotely and there is a low risk of an alternative diagnosis, and the prescriber is confident that antimicrobials are needed. If antimicrobials are prescribed remotely the person should know when and how to seek further medical help.
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Proportion of prescriptions for antimicrobials for adults with an acute respiratory infection that are given without a face-to-face assessment.
Denominator – the number of prescriptions for antimicrobials for adults with an acute respiratory infection.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from electronic patient records. Local areas may wish to compare variation in achievement levels in the context of population needs.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from electronic patient records. NHS England's optimising antimicrobial use dashboard includes data on prescribing volume in primary care for specific antibiotics that can be used to treat acute respiratory infection in primary care. Results can be compared across different localities and age groups, however, the indication for use is not reported.
Service providers (such as NHS 111, general practice, acute respiratory infection hubs and community pharmacies) have protocols and processes in place to ensure antimicrobials are not routinely prescribed to adults first presenting with suspected acute respiratory infection based only on remote assessment.
Healthcare professionals (such as NHS call handlers, GPs, advanced care practitioners, nurse practitioners and community pharmacists) ensure they do not routinely prescribe antimicrobials to adults first presenting with suspected acute respiratory infection based only on remote assessment. They arrange face-to-face assessments if antimicrobials may be needed.
Commissioners ensure that they commission services that do not routinely prescribe antimicrobials to adults first presenting with suspected acute respiratory infection based only on remote assessment. They ensure clear pathways are in place for face-to-face assessments to be carried out in an appropriate setting based on severity of symptoms, rate of deterioration and presence of any comorbidities.
Adults with suspected acute respiratory infection are not usually given antiviral or antibiotic treatment based only on a remote assessment. If they may need antiviral or antibiotic treatment, they will usually have a face-to-face assessment.
An acute illness (present for 21 days or less) affecting the respiratory tract with symptoms such as cough, sore throat, fever, sputum production, breathlessness, wheeze or chest discomfort or pain, and no alternative explanation. [NICE's guideline on acute respiratory infection in over 16s, terms used in this guideline section]
Commissioners should work with providers to tackle higher antibiotic prescribing rates in more deprived areas. Prescribing targets should reflect the needs of the local population.
Healthcare professionals should recognise that some pulse oximetry devices have been reported to overestimate oxygen saturation levels in people with darker skin. Adjustments should be made when interpreting the test results to ensure that treatment is provided when appropriate.
Adults should be supported to ensure they can communicate effectively with NHS services during remote and face-to-face assessments. For remote assessments this should include making sure the person is able to use any digital technology and offering alternatives, when necessary. It also includes ensuring services are accessible to those who do not speak or read English. Adults should have access to an interpreter or advocate, if needed. Any support provided should be culturally and age appropriate.