Strategies to Improve Antibiotic use Flashcards Preview

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Flashcards in Strategies to Improve Antibiotic use Deck (19)
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1
Q

What is the problem with antimicrobial resistance?

A

Increased risk of worse clinical outcomes and death

Consume more healthcare resources

2
Q

How do drug resistant strains arise?

A

•The use and misuse of antimicrobials accelerates the emergence of drug-resistant strains.

3
Q

What is antimicrobial stewardship?

A

Balances managing infections with the outcomes of the patient and the wider society

4
Q

What is the UK 5 year antimicrobial resistance strategy?

A

Improve knowledge and understanding of AMR

Conserve and steward the effectiveness of existing treatments

Stimulate the development of new antibiotics and novel therapies

5
Q

What type of intervention is effective when trying to improve antibiotic presecribing?

A

•Advice/feedback more effective than restrictive interventions

6
Q

What is the SAPG?

A

Scottish antimicrobial prescribing group

Co-ordinates & delivers a national framework for antimicrobial stewardship to enhance the quality of antimicrobial prescribing & management in Scotland

Provides guidance on antimicrobial stewardship to improve the quality of antimicrobial use

7
Q

What are some of SAPG successes?

A

Decrease in CDIFF rates in scotland

New data systems

Development of new training materials

Improved clinical management of infections (CAP, sepsis 6)

8
Q

What is the HEAT target for hospital prescribing?

A

–Indication for antibiotic is documented and compliant with local policy

–Duration of oral antibiotics is documented and compliant with local policy

9
Q

What are the current targets?

A

–IV antibiotic review within 72h and outcome is documented

–1% Reduction in overall antibiotic consumption

–1% Reduction in carbapenem consumption

–1% Reduction in piperacillin/tazobactam consumption

10
Q

What are the trends in antibiotic use in primary care and acute hospitals?

A

Primary care - decreasing

Hospitals - increasing

11
Q

What are NHS grampian strategies?

A
  • Policies & guidelines
  • Audits and feedback
  • Surveillance data
  • Education
12
Q

Give examples of policies and guidelines within NHS grampian?

A
  1. Empirical guidelines
  2. Documentation & review/stop date (drug Kardex documentation)
  3. IVOST policy (IV to oral switch therapy) - IV antibiotics moved to IV administration if certain criteria are met
  4. Penicillin allergy
  5. Alert Antimicrobials - under authorisation of microbiologist or infectious disease specialist, and/or according to approved indications within local guidelines / policies
  6. Gentamicin
  7. Vancomycin
13
Q

What are the criteria needed for the IV to oral switch therapy?

A

Patient is improving clinically

Patient is able to tolerate an oral formulation

All the criterion below are met:

Able to swallow and tolerate fluids

Temp. 36-38°C for at least 48 hours

Heart rate < 100bpm for previous 12 hours

WCC between 4 and 12x109L

NOT SWITCH:

  • Oral route compromised, continuiing sepsis, special indication (endocarditis, meningitis, staph aureus), febrile neutropenia, hypotension/shock
14
Q

What are the audits and feedback?

A
  • Large point prevalence audits annually
  • SAPG quality improvement audits
  • Smaller ad-hoc audits
15
Q

Give examples of survillance data

A
  • Antimicrobial trends using DDDs and bed days for comparison across hospitals
  • Antimicrobial resistance – on demand
  • Hospital-acquired infections – IPCT
  • National systems include HMUD, Antibiotic use in Humans 2012-2016 Database and HPS
16
Q

What are the sources of education

A
  • Regular training sessions for medical students and junior doctors
  • ScRAP
  • On-line resources e.g. NES, Learn Pro, TURAS
  • European Antibiotic Awareness Day
  • General public
17
Q

What are examples of NHS grampian successes

A

Reduction in CDI

MRSA rates have fallen

ESBLE rates relatively stable (extended spectrum beta lactamases - extremely resistant bacteria)

18
Q

How can healthcare wokers help tackle AMR?

A
  • Practicing effective infection prevention & control
  • Prescribing and dispensing antibiotics only when truly needed (correct indication)
  • Prescribing & dispensing the right antibiotic(s) for the right duration to treat the illness (correct prescribing)
19
Q

How can everybody help tackle resistance?

A

Use antibiotics only when prescribed

Complete the full course

Never share antibiotics or use leftover prescriptions