Antimicrobial Stewardship and AMR update BGSW Practice Nurse - PowerPoint PPT Presentation

Antimicrobial Stewardship and AMR update BGSW Practice Nurse meeting #antibioticguardian @elizbeech Elizabeth Beech Healthcare Acquired Infection and Antimicrobial Resistance Project Lead NHS England November 2015 elizabeth.beech@nhs.net www.england.nhs.uk

You are invited to become an Antibiotic Guardian today (available via mobiles) Implementation of national AMS toolkits in England Dr Diane Ashiru-Oredope www.england.nhs.uk 2 AMR: Strategic Overview Dr Diane Ashiru-Oredope

www.england.nhs.uk

www.england.nhs.uk

Superbugs to kill 'more than cancer' by 2050 www.england.nhs.uk

www.england.nhs.uk

In the UK If we fail to act, we are looking at an almost unthinkable scenario where antibiotics no longer work and we are cast back into the dark ages of medicine – David Cameron, UK Prime Minister Fears grow over increased antibiotic resistance BBC 16 October 2015 UK experts said the study confirmed their fears that antibiotic resistance would affect routine surgery. England's chief medical officer has called the issue a ticking time bomb www.england.nhs.uk

www.england.nhs.uk

G7 Health Ministers meeting Oct 2015 Antibiotic consumption links to AMR www.england.nhs.uk

www.england.nhs.uk

AMR: individual risk Risk of resistance persists for at least 12 months in individuals after each intake of an antibiotic Increased risk of resistant organism Antibiotic in past Antibiotic in past 2 months 12 months UTI 2.5 times 1.33 times 5 studies: n = 14,348 RTI 2.4 times 2.4 times 7 studies: n = 2,605 A meta analysis of English Primary Care Costello et al. BMJ. ( 2010) 340:c2096. 11 AMR: Strategic Overview Dr Diane Ashiru-Oredope

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UK 5-year AMR Strategy 2013 -18 ‘One Health ’ Strategic aims CMO Annual 1. Improve the Report 2011* knowledge and understanding of AMR 2. Conserve and steward the effectiveness of existing treatments 3. Stimulate the development of new antibiotics, diagnostics *published: March 2013 and novel therapies 13

UK 5-year AMR Strategy 2013-18: Seven key areas for action DH – High Level Steering Group PHE Defra DH Human health Animal health • 5) Improving the evidence • 1) Better access to and use of base through research surveillance data • 6) Developing new drugs, • 2) Optimising prescribing practice vaccines and other • 3) Improving infection prevention and diagnostics and control treatments • 4) Improving professional education, • 7) Strengthening UK and training and public engagement international collaboration Presentation title - edit in Header and Footer

Antimicrobial Prescribing Quality Measures Table 3: ARHAI recommended antimicrobial prescribing quality measures October 2014 Primary care Secondary care Total antibiotic prescribing to be Measures to Total antibiotic consumption to be reduced to 2010 levels at CCG reduce total reduced by 1% per year 2015- level as measured by number of antibiotic 2019 as measured by DDD per antibiotic prescriptions (“items”) prescribing 1000 admissions per year. per 100 patients per year Proportion of antibiotics from cephalosporin, quinolone or co- amoxiclav classes to be reduced Measures to Total carbapenem consumption to to less than the current median for encourage narrow be reduced to 2010 consumption English CCGs as measured by spectrum antibiotic levels as measured by DDD per the number of prescriptions prescribing 1000 admissions per year. (“items”) from target classes in comparison with the total number of antibiotic prescriptions per year.

ESPAUR 2014 and 2015 • Key element of the 5 year AMR strategy was to introduce surveillance systems for antimicrobial resistance and usage • 1 st English data for antimicrobial usage data for hospitals AND community in 2014 report • 2015 report out now – read it www.england.nhs.uk

ESPAUR 2015 - Antimicrobial consumption • Antibiotic prescribing has increased in England 2014 on 2013 but more slowly, by 2.4% • Primary care items per STAR-PU ↓ • but DDD per1000 inhabitants per day ↑ • Broad spectrum antibiotic use is ↓ to 8.5% • Primary care accounts for 75% of all prescribing • Inpatient and OP antibiotic use continues to increase www.england.nhs.uk

www.england.nhs.uk

Patient Harm – prevent and reduce Patients with AMR have 2-3 times higher • mortality and risk of complications • CDI rates are rising in 2015 Co-amoxiclav use ↑ resistance ↑ • association with CDI ↑ • E.coli bacteraemia rates are increasing • CAUTI remain a concern • Carbapenemase-producing Enterobacteriaceae CPE surveillance for all NHS organisations and global increasing resistance – avoid use • Sepsis – National CQUIN for 2015/16 www.england.nhs.uk

New guidance and incentives in 2015 • 2008 Health & Social Care Act Code of Practice now includes AMS – criterion 3: ensure antibiotic use optimises outcomes & ↓ risk of adverse events and AMR. Applies to dentists and GP practices also • NHS England patient safety alert August 2015 • NICE guidelines NG15: Antimicrobial Stewardship • NICE guidelines consultation changing risk-related behaviours in the general population • Start Smart then Focus and TARGET stewardship toolkits • NHS England 2015-16 Quality premium for CCGs • NHS England CQUIN on Sepsis for acute care providers www.england.nhs.uk

NHSE Antibiotic Quality Premium 2015-16 and what it means for CCGs The Antibiotic element has 3 parts, 2 relate to primary care prescribing (80% of payment) • Reduction in the number of antibiotic prescriptions by 1% as measured by population – antibacterial items per STAR-PU • Reduction in the proportion of broad spectrum antibiotics (cephalosporins, quinolones & co-amoxiclav) by 10% from 2013-14 baseline or to stay below England 2013-14 median value of 11.3% • Validation of acute provider antibacterial consumption data for PHE • CCGs have individual targets published on NHSE Quality Premium webpage www.england.nhs.uk

Antibiotic prescribing variability – CCG level www.england.nhs.uk

Antibiotic prescribing variability – by GP practice www.england.nhs.uk

Antibiotic prescribing variability – by GP practice www.england.nhs.uk

Antibiotic prescribing variability – by GP practice www.england.nhs.uk

Antibiotic prescribing variability – by GP practice www.england.nhs.uk

Antibiotic prescribing variability – by NMP www.england.nhs.uk

Antibiotic prescribing variability – by NMP www.england.nhs.uk

Antibiotic prescribing variability – by NMP www.england.nhs.uk

NHSE Antibiotic Quality Premium dashboard www.england.nhs.uk

National Antibiotic Quality Premium dashboard www.england.nhs.uk

NHS England Area Antibiotic Quality Premium dashboard www.england.nhs.uk

NHS England Area Antibiotic Quality Premium dashboard www.england.nhs.uk

NHSE Antibiotic Quality Premium dashboard www.england.nhs.uk

CCG performance versus target and all England www.england.nhs.uk

CCG performance versus target and all England www.england.nhs.uk

PrescQIPP AMS Hub https://www.prescqipp.info/ ��������������������������������������� � ������������������ ������������������������������������������������������������������� ��������� �!����������������""#�������$�������������%��$&���������'���������������$� ��(������)������ �������������*���������������������������������� +�������������,����-������������������$�.������� ���� �!������������������������� ����������!��������������%�������� ���������������&��������� �������������������������������������������'�� ��������$���������������������������%�!���������'�$� �����������'��������������������������%���������'�&� � Free access Lots of links to resources Primary care prescribing data – use it and contribute www.england.nhs.uk