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Shared Learning: Innovation and Technology

Projects that demonstrated innovative approaches to tackling antimicrobial resistance

 

2017 Entries

 

Heart of England NHS Foundation Trust (Winner – Antibiotic Guardian Awards 2017)

Name: Shahzad Razaq, Principal Pharmacist for Medicine & Anti-Infectives

Brief overview of the project: Mortality from sepsis is reduced if antibiotics are prescribed and administered without delay. Administration of the STAT antibiotic must be regarded as urgent and should be commenced within one hour. In 2013, at Heart of England Foundation Trust (HEFT), only 40% of patients received their antibiotic within one hour, which was similar to the reported national performance for sepsis treatment in acute medical units. We set out to improve this by a structured quality improvement (QI) project in order to improve our time to administration performance to an aspirational target of 80 %.

An Electronic Dashboard was initially developed and made available for staff to view performance of administration of STAT doses by ward/hospital site. Working with the education team we improved nurse IV cannulation and reconstitution of drugs competencies. We developed an iSkills video for training of ward managers, pharmacists and porters on using the dashboard. Extensive ward-ward education of junior doctors was done to a) emphasise the roll of effective direct communication with the nurse looking after the patient prescribed a stat dose b) to ensure antibiotic stat doses are only prescribed for sepsis c) to administer the drug themselves if the nurse is not available.

Crucial to the further and sustained improvement in the timely administration of antibiotic STAT doses has been the deployment of bleep/pagers to each Electronic Prescribing(EP) ward in the Trust.

Linking our electronic prescribing system automatically to our bleep system was our key innovation.

These pagers bleep to inform the nurse that a STAT dose has been prescribed, and continues to bleep at 15 minute intervals until the STAT dose is administered or the time to administer the dose has lapsed. Accessing the electronic dashboard allows the nurse to identify which patient(s) have been prescribed STAT doses.

Performance relating to the timely administration of the STAT doses is now being routinely reported as a nursing metric at executive level, broken down to hospital site and ward level. This has resulted in the improvement project now being fully integrated as part of the culture of our organisation.

The Trust performance for administration of STAT doses of antibiotics within one hour now stands at 82.3% (average of last 28 days [25/02/17 – 26/03/17]). This represents a 105 % improvement since our 2013 baseline.

List any supporting partners or organisations worked with: The core team comprising the ‘Antibiotic Safety Team’ included consultant microbiologist, antibiotic pharmacists, ICT developers, patient safety team and corporate nursing. To help us deliver the project recruitment of ward pharmacists, education leads, medical illustration and Trust communication team was crucial. Underpinning this whole development was the talent of our software development team, who were able to develop our unique dashboard and link our EP system with our bleep system.

How has your project demonstrated success in highlighting antibiotic stewardship within your chosen category? This project demonstrates that innovation technology has been used to improve antibiotic safety for patients with sepsis. We programmed and linked our Trust Electronic Prescribing JAC system to send information via the pager system to alert nursing staff of urgent medication to be administered which they can then view on a unique Trust Intranet Dashboard is unique in enabling nurses to administer urgent doses to patients.

Protecting antibiotics is not only ensuring reducing inappropriate prescriptions, but to ensure when prescriptions are indicated they are given on time and are not missed. Our dashboard-bleep electronic system has enabled us to secure urgent antibiotic administration in our Trust.

Cite 3 examples within the project which highlight promotion of the protection of antibiotics? Use of antibiotics promptly for patients with sepsis has been shown to reduce mortality and morbidity. Mortality is reported nationally as HSMR. In 2016 HEFT HSMR was 89.7 which is below the average for Midland’s trusts of 92.7 and has shown a favourable downward trend; of 137 trusts the Trust was positioned at 45, the lowest position being best.

Patients treated on time have reduced length of stay and therefore do not require extended courses of antibiotics which may lead to resistance. This has contributed to us being now the 111th (128 submitted on PHE fingertips) lowest hospital antibiotic users in England, as documented by Total DDDs per 1000 admissions at end of Q2 2016/7.

The bleep/dashboard help ward managers review where lapses are occurring so that measures can be put in place to reduce the number of missed doses of urgent antibiotic treatment. Missed doses may result in sub-therapeutic concentration of antibiotics which is a known risk factor for the selection of antimicrobial resistance.

Key outcomes of project?: Approximately 1500-2000 antibiotic stat doses are prescribed at HEFT per month. Over 80% of these patients now receive their STAT dose antibiotic within one hour. This compared with 40% at the start of project in 2013.

Many QI projects fade after initial gains. Our project is an exemplar of sustainability. We have consistent improvement over the last 18 months of STAT administration of antibiotics >80% for patients with sepsis.

We showed it was possible to succeed in a QI project at huge scale, in a large Trust with 3 different hospital sites with 11,000 staff.

How is the project to be developed in the future?: We have begun sharing our development model on antibiotic safety in sepsis with other hospitals that use JAC Electronic Prescribing system.

We are extending the use of pager bleep for other time critical medicines within HEFT. It has now been successfully implemented for another group of time critical medications i.e. Parkinson’s drugs.

We are planning on extending our project to non-electronic prescribing areas

 

NHS Sandwell and West Birmingham CCG (Highly Commended – Antibiotic Guardian Awards 2017)

Name: Shabana Ali

 

Brief overview of the project: The SWBCCG antibiotic protection project aims to increase understanding of the issue of antibiotic resistance and motivate antibiotic stewardship in a highly innovative and inspirational manner.

Having tackled the issues of unnecessary antibiotic prescribing using innovative methods to change prescribing behaviour at GP level, we had to take it to the next level, including our patients in improving their knowledge and understanding of the topic. The main challenges we had to address in the patient arena were the wide variation in their understanding of antimicrobial resistance, the varied demographic population in this CCG, and the beliefs of the different types of communities we serve. This led to the introduction of a patient/public education and engagement program.

From the offset, the antibiotic protection project has been underpinned by education and awareness delivered to a wholly inclusive population by a variety of mechanisms to elicit a change in demand, and prescribing habit. Patient groups that we normally work with are linked to GP practices and have proactive patients attending who already have some basic knowledge of such issues, and we needed to speak to patients who aren’t as proactive or knowledgeable in this area.

We developed engagement strategies for the different communities including migrant groups to deliver a multi-faced education programme. The highest prescribers of antibiotics within the CCG were identified, and we targeted populations around these practices for education. Patients were ultimately at the centre of this project, we raised awareness across our demographic population by working with churches, temples, various patient groups and specific community groups to convey our key educational messages, with the intention that they take the messages back home to their friends and families. We have reached out to a wide audience via a BBC Asian Network radio discussion with antibiotic resistance as the topic.

After having reviewed all of our engagement techniques the decision was made to take the subject to patients targeting high prescribing practices. Each locality team identified 2 high prescribing practices in their area including walk-in-centres and organised an event, during World Antibiotic Awareness Week, to educate the public and measure patient learning pre and post antibiotic talk. We were also approached by our neighbouring CCG who were delivering educational sessions to community pharmacies, and we have now launched a similar programme of training to Pharmacies in SWBCCG to ensure a consistent approach across the STP.

 

List any supporting partners or organisations worked with:

  • Microbiology & Lead Pharmacist for antimicrobials from SWBH NHS Trust – Local secondary care Trust
  • Health Futures College
  • Sandwell Academy
  • King Edwards School
  • Schools in Sandwell & West Birmingham
  • Rights & Equality Sandwell
  • Church – various
  • Temple – various
  • University of the third age (U3A)
  • BBC Asian Network
  • Local Pharmaceutical Committee
  • Public Health – Sandwell & Birmingham
  • Cross City CCG

 

How has your project demonstrated success in highlighting antibiotic stewardship within your chosen category: Having evaluated feedback from both GPs and patients it was clear that the key to sustaining appropriate prescribing would be to engage with patients as well as clinicians. We had already presented at patient network groups etc. about antibiotic resistance and had anecdotal evidence that our project was successful. On evaluation of our target audience, we decided that we needed to engage with patients who are not as proactive on accessing information as those that we had been speaking to. The next step was to take the information to our patients. I addition to this, we needed to measure the outcome of our events, in order to evidence the difference we were making. So a tool was developed to enable us to measure patients understanding before and after we discussed the topic of antibiotic resistance with them. The tool we used during patient engagement was in the form of a quiz which was split into 2 sections, the first section to be completed before the discussion, and the second after.

This talk proved to be very useful in explaining what antibiotic resistance really is. Many patients thought they knew what antibiotic resistance was because they had heard people refer to the term, but the majority of them didn’t know the process or the implications.

The results from this piece of work were as follows from 154 responses:

Sandwell_Quiz_Responses

 

NHS Leeds North Clinical Commissioning Group (Highly Commended – Antibiotic Guardian Awards 2017)

Name: Heather Edmonds, Head of Medicines Management

Brief overview of the project:Development of resources suitable for people with learning disabilities and people for whom English is not their first language.

Leeds North CCG is the lead commissioner for “Learning disabilities” services within the Leeds city areas. As part of this role we try to recognise the needs of people with learning disabilities and support them to access services and information to support their health needs.

Leeds is the most diverse city in England outside London with a population of 800,000. There are at least 84 different languages spoken with Leeds. There are about 50,000 people for whom English is not their main language and over 10,000 people who do not speak English well or at all http://www.claritysocialenterprise.org/leeds-languages/). Many of these people do read their own language therefore translating any information does not always solve the problems and not always cost-efficient.

Taking these issues into account we worked with a number of agencies to seek the best way to support these patients. The outcome of this work was to develop a patient information leaflet that was pictorial, but contained more detailed safety netting information on the reverse, as usually friends or other family members are able to read English and also to develop translated leaflets in the most common languages.

Supporting partners or organisations worked with:

Service User Involvement Facilitator, Learning Disability Service, Leeds and York Partnership NHS Foundation Trust.
Commissioning Manager, Learning Disabilities & Autism, Leeds Clinical Commissioning Groups Network.
GP, who works with a multi-ethnic population and understands the issues around language.
Leeds Involving People.

How has your project demonstrated success in highlighting antibiotic stewardship within your chosen category:

On behalf of the Leeds CCGs Leeds Involving People carried out 7 focus group consultations across various ethnic groups. We had very positive feedback, with members of the focus group reflecting that they had seen the leaflets within their GP practices. Comments fed back from the focus groups:-

• Bold, large font in black and white was the most noticeable and accessible wording format. This was particularly appreciated by those with sight problems.
• Use of humour and striking images, such as the unhappy face, were engaging and aided the message of the text.
• Participants noted that the use of engaging images would be appealing to children and some people with learning difficulties.

Feedback from health professionals working with learning disabilities :

“This looks a great piece of work that would focus as a good tool for practitioners and help raise people’s understanding”
“it looks brilliant. I’m sure it would work well with our client group“
“I like it”
The results of the project showed that we had produced a set of leaflets that were appropriate for our target audience, were being used by our GP practices and that the sample of people who attended the focus groups found the materials memorable and remembered seeing the leaflets even after several weeks. It also meant that the messages around antibiotic stewardship were reaching as wide a range of the population as possible.

This was demonstrated by our evaluation of the campaign as we asked people who recalled seeing campaign material what they felt the main campaign message was. People could enter what text they wanted, and this was content analysed. The top four themes people suggested were:

• Antibiotics are not effective on coughs, colds and sore throats (43.7%).
• Antibiotics do not work on viral infections (22.2%).
• To raise awareness of AMR (11.7%).
• Try not to use antibiotics (11.1%).

Cite 3 examples within the project which highlight promotion of the protection of antibiotics? Max 400 words:

  • The development of the easy read leaflet
    • Development of several antibiotic leaflets in various languages
    • The positive fed back from patients and health care professionals

Key outcomes of project?:

The development of the easy read leaflet, which had positive feedback and helped to ensure that key messages around antibiotics were accessible to a section of the population that currently no leaflets have been developed for.
How is the project to be developed in the future?

We intend to use this approach to work with our population to continue to develop materials that are accessible to our whole population to deliver key messages about antibiotics, such as resistance. We are happy to make these resources available to other CCGs and practices in other areas.

 

Leeds

Antibiotics Campaign – Update February 2016

Appendix

 

Schools

 

Contact has been made with the following 68 Primary schools:

 

School
Park View Primary Academy
Brown Hill Primary Academy
Woodlands Primary Academy
Pudsey Tyersal Primary School
Pudsey Bolton Royd Primary School
Wigton Moor Primary School
Broadgate Primary School
Beecroft Primary School
Blenhiem Primary School
Brudenell Primary School
Iveson Primary School
Kirkstall Valley Primary School
Little London Primary School
Lawnswood School
Quarry Mount Primary School
Spring Bank Primary School
Rosebank Primary School
Adel Primary School
Weetwood Primary School
Bankside Primary School
Chapel Allerton Primary School
Gledhow Primary School
Talbot Primary School
Bracken Edge Primary School
Kerr Mackie Primary School
Alwoodley Primary School
Carr Manor Primary School
Highfield Primary School
Moor Allerton Primary School
Moortown Primary School
Ebor Gardens Primary School
Harehills Primary School
Hovingham Primary School
Richmond Hill Primary School
Seacroft Grange Primary School
Wylebeck Primary School
Shakespeare Primary School
Greenmount Primary School
Hunslet Moor Primary School
Middleton Primary School
Ingram Road Primary School
Hugh Gaitskell Primary School
Armley Primary School
Farsley Farfield Primary School
Burley St Matthias C of E Primary School
Christchurch Upper Armley C of E Primary
St Bartholomews C of E Primary School
St Chads C of E Primary School
Roundhay St John’s C of E Primary School
St Anthony’s Catholic Primary School
St Augustine’s Catholic Primary School
Christ the King Catholic Primary School
St Francis of Assisi Catholic Primary School
Holy Family Catholic Primary School
Corpus Christi Catholic Primary School
St Joseph’s Catholic Primary School
St Nicholas Catholic Primary School
Sacred Heart Catholic Primary School
St Phillip’s Catholic Primary School
St Patrick’s Catholic Primary School
Holy Rosary and St Anne’s Catholic Primary School
Adel St John the Baptist C of E Primary School
St Mathews C of E Primary School
All Saints C of E Primary School
St Peter’s C of E Primary School
Beeston Hill St Luke’s C of E Primary School
Shire Oak C of E (VC) Primary School
Mill Field Primary School
Allerton C of E Primary School

 

Engagement with Community Groups/Venues

 

Engagement (leaflets, posters, talks) in the appropriate language with the following 37 groups/venues:

 

Community group/venue, area and demographic
Advonet, city-wide, various
Hamara Centre, Dewsbury Road, South Asian men and women
Dosti, Armley, South Asian women
Healthy Living Network, city-wide, various
Iqra Centre, Moortown, Muslim
Feel Good Factor, Harehills, various
Beeston Business Bengali Centre, Harehills, Bengali speaking community
Better Leeds Communities, Burley, various
Health for All (Sangum Group), city-wide, Sikh and Hindu community
Leeds Refugee Forum, city-wide, Refugee and Asylum Seekers.
Leeds Black Elders, city-wide, Black Elders
Leeds Chinese Community Association, city-wide, Chinese
Leeds Kashmiri Elders Association, city-wide, Kashmiri
Leeds Swahili Culture Community, East-End Park, Swahili
Leeds Migrant Community Network, city-wide, various
Nari Ekta, city-wide, Asian women
PAFRAS, Harehills, Refugee and Asylum Seekers
Polish Saturday School, city-wide, Polish
Prince’s Trust, city-wide, young people
Russian Speakers Club, city-wide, Russian speakers
Shantona Women’s Centre, Harehills, Asian women
Sikh Elder’s Service, city-wide, Sikh
Swallow Hill Community College, Armley, various
Women’s Asylum Seekers Together, city-wide, Asylum Seekers
Touchstone, city-wide, various
Women’s Health Matters, city-wide, various
Woodhouse Community Centre, Woodhouse, various
Somali Group, city-wide, Somalian
Lincoln Green Support Centre, Burmantofts, various
East Leeds Health for All, LS9, various
Osmondthorpe Resource Centre, LS9, various
Ramagrahia Board, Chapeltown, Sikh
Unity Housing Association, Chapeltown, various
One-Stop shops, city-wide, various
Sangam Group, city-wide, South Asian
Leeds Irish Health and Homes
Migrant Community Network

 

Engagement with places of worship

 

Engagement (leaflets, posters, talks) in the appropriate languages with the following places of worship:

 

Place of worship
Lincoln Green Mosque, Burmantofts
Masjib E Quba Mosque, Harehills
Muslim Cultural Society, Harehills
Makki Masjid and Madrasa Mosque, Burley
Kashmir Muslim’s Community Centre and Mosque, Dewsbury Road/Beeston
The Baab ul ilm Centre Mosque, Alwoodley
Al Madina Mosque, Woodhouse
Grand Mosque, Hyde Park
Islamic Centre/Central Jamia Mosque, Chapeltown
Jamia Masjid Ghousia Mosque, Armley
Leeds Aqra Mosque, Harehills
Shahjalal Jamia Masid, Harehills
Makkah Masjid Mosque, Woodhouse
Hindu Temple, Woodhouse
Sikh Temple, Chapeltown
Sikh Temple, Chapeltown
Sikh Temple, Harehills
Sikh Temple, Armley
Sikh Temple, Beeston
Hope Centre, African
Living Hope Church, African

 

Shops

 

Leaflets have been distributed in the following shops:

 

Shop and area
Polish/Eastern European Shops LS7
Polish/Eastern European Shops LS8
Polish/Eastern European Shops LS9
Polish/Eastern European Shops LS12
Teck Newsagent, Dewsbury Road
Select Housing, South and North Leeds
Catlows, Dewsbury Road
Sweeny Todd Hairdressers, Chapeltown
Anands, Harehills
Dutch Pot, Chapeltown
Pretty Woman, Chapeltown
Medina, Chapeltown
Morrisons Hunslet

 

Talks

 

Talks have been arranged with the following 24 groups/venues:

 

Group/venue
Mosque
Sikh Temple
Sikh Temple
Sikh Temple
Black Elders group
Migrant community – Czech and Slovak Roma; Eritrean, Syrian, Ethiopian and Afghan
Refugee and Asylum Seeker workshop
Female Asylum Seekers
English Language class – Kurdish and Arabic
Swahili Women’s group
Sangam group
Polish Parents group
Bangladeshi and Iranian Parent group, Hunslet
Parent group
Advonet Advocates
Afghan Women’s Association
South Asian men’s group
South Asian women’s group
Leeds Combined Arts, BME mixed
Syrian community
Prince’s Trust, young BME mixed
Shantona, South Asian women
Dosti, South Asian women
Nari Ekta, South Asian women

 

Brighton & Sussex University Hospitals NHS Trust

Name: Samantha Lippett, Lead Antimicrobial Pharmacist

Please provide a brief overview of your project? Max 400 words: Following a Pharmacy scoping visit to University Teaching Hospital & The University of Zambia in Lusaka, Zambia during April 2016 it was identified that although antimicrobial stewardship is cited as a priority it is not formally taught on the undergraduate curriculum. An agreement was reached with the University of Zambia to include antimicrobial stewardship within the final year curriculum for pharmacy undergraduates, medical students and nursing students. The Lead Antimicrobial Pharmacist at Brighton & Sussex University Hospitals took responsibility to write & record a lecture on this subject using recording equipment at Brighton & Sussex Medical School for use by the University of Zambia. Care was taken to produce the lecture recording in small sections so that the file could be successfully downloaded in Zambia given the restrictions with their internet speed.

List any supporting partners or organisations worked with: Brighton – Lusaka Health Link (registered Charity)
Brighton & Sussex Medical School
University of Brighton
University of Sussex
University of Zambia
University Teaching Hospital, Lusaka, Zambia

How has your project demonstrated success in highlighting antibiotic stewardship within your chosen category? Max 400 words: All healthcare undergraduates that will influence antibiotic prescribing once qualified have access to tailor made teaching materials on antimicrobial stewardship relevant to Zambia.

Cite 3 examples within the project which highlight promotion of the protection of antibiotics? Max 400 words: Lecture included:-
* concept of ‘review and revise’ by 72 hours for all antibiotic prescriptions.
* influence of animal use of antibiotics on human healthcare
* WHO perspective on antimicrobial resistance
* how to monitor antibiotic consumption utilizing ‘defined daily doses’

Key outcomes of project?: To have antimicrobial stewardship formally included in the undergraduate curriculum for pharmacy, medical and nursing students in Zambia hence raising awareness for when they become practitioners themselves.
Note: All healthcare practitioners in Zambia are trained in Lusaka at the University of Zambia

How is the project to be developed in the future?: Develop further antimicrobial stewardship educational resources to be used within the undergraduate courses e.g. case based learning
Promote access of the recorded lecture to existing pharmacy, medical & nursing staff
Supporting University Teaching Hospital (UTH), Lusaka to monitor antibiotic consumption in areas of high usage (current priority is the neonatal unit)
Implementation of the Microguide App within UTH to disseminate locally produced antimicrobial prescribing guidelines

 

2018 Entries

 

ABP UK

Provide a brief overview of your project:

Working with AHDB and SRUC – Blade Farming part of ABP UK are trialling a project:

‘Enhanced monitoring systems for improved health management of dairy-bred beef Young stock.’

The aim of this project is to identify the most appropriate strategies for detecting illness in individual dairy-bred calves during the rearing phase and to develop improved calf health management protocols based on improved monitoring and more targeted treatment. Methods Blade Farming are using are:

– Wisonsin Scoring visual signs of health and correctly identifying illness / disease.

– Pedometers sensors measuring activity 24:7. Calf activity is monitored daily. Any animal that has exceeded ‘normal’ lying time is investigated immediately.

– Health recording sheet matrix to accurately identify illness and administer correct medicine

– Dosing Applicator linked to EID weigh scales which records each calf weight accurately. The dosing applicator then automatically calibrates the correct measure of vaccine for the individual calf. So reducing under and over administration. Improving effectiveness but also waste.

– Weather stations which monitor the inside and outside conditions –shed design have been altered to improve conditions when necessary. It is also another tool to effectively monitor the ever changing weather conditions we experience in the UK.

– Calves are batched according to age and we expect a fill time of maximum of 10 days on a unit. This helps reduce spread of disease.

– Calves are on individual rearing plan linked to EID ear tags at the automatic milk machine system. Each individual calf receives the correct quantities of milk powder according to their weigh, age etc.

– Units are linked up to Wifi to send instant data to our calf rearing managers and individual farms to monitor remotely and with the potential to intervene when required if something has been missed.

Cite 3 examples within the project which highlight promotion of the protection of antibiotics?:

  1. Detecting the onset of illness sooner in its life cycle will ultimately – So a more proactive approach to detect the disease faster, so reducing the amount and potential to reduce further treatments
  2. Blade Farming operates a high heath status rearing programme. For example bio-security stations (footbaths), daily teat disinfection to reduce cross contamination.
  3. All in All out system where calves arrive in batches of a similar age over a 10 day fill. The unit is then closed down where no further calves are added reducing again cross contamination from farms and calves of different ages. After every batch the unit is mucked out and disinfected routinely.

How is the project to be developed in the future?:

The findings of the project will be used to develop and introduce a new and improved health protocol/ management system.

By being able to accurately detect disease sooner in a calves life it ultimately improves the chances of full recovery but also eliminates the spread of disease to others calves in the unit.

It also helps to stop the need to batch treat the whole unit.  Linking diagnosis to correct treatment will also be improved by using the automatic dosage applicators – which is very important in our client and fear of AMR.

Ultimately we are looking to produce the SMART calf rearing shed with the most improved rearing protocols. So improving animal health and welfare, reducing antibiotic usage on farm and reducing waste and cost.

 

Leicester City CCG (Winner – Antibiotic Guardian Awards 2018)

Provide a brief overview of your project:

The project focussed on trying to use technology for sustained education and good practice in line with the 3 NHSE QP target for primary care within the 3 CCG at Leicester, Leicestershire and Rutland (LLR) .

  1. Reduction in the number of gram negative blood stream infections
  2. Reduction in Trimethoprim Items Prescribed to Patients aged 70 years or greater
  3. Reduction in Trimethoprim: Nitrofurantoin Item Ratio

The 3 CCG antimicrobial pharmacist along with the care home pharmacist did the following

  • Changed the LLR Primary care antimicrobial guidance UTI section to include details of diagnosis of UTI for >65 year olds men and women in line with the PHE guidance and separated this from the diagnosis of UTI of elderly >65 year olds in line with SIGN guidance
  • Nitrofurantoin was made first choice and trimethoprim a second choice
  • Discuss and collect all the resources available to help support this and design a care home template (with workshops and consultation with care home staff and GP’s) and a hydration tips leaflet. We also compiled other resources available from our neighbouring CCG and Target website
  • These resources were hosted on the LMSG website and several workshops conducted to educate care home staff and prescribers in addition to newsletter and presentation
  • Collaborated with our Health Informatics Service and built UTI template to help diagnose UTI in elderly incorporating the principles of SIGN guidance and in addition improving read coding by linking the symptoms to read codes when this is ticked by the prescriber for the patient
  • Prompt prescribers to use the template by firing when they type in cue words related to UTI and also at the point of prescribing antibiotics through the OPTIMISE system.

Cite 3 examples within the project which highlight promotion of the protection of antibiotics?:

  1. Utilise GP prescribing system to help diagnose UTI in line with SIGN algorithm in the elderly group
  • Leicester City CCG : 58 SystmOne practices and1EMIS practice
  • West Leicestershire CCG : 30 SystmOne practices and 18 EMIS practice
  • East Leicestershire CCG :20 SystmOne practices and 11EMIS practice

Evidence from the attached NHSE dashboard data, this has helped reduce numbers and achieve the above three targets we aimed for the 3 CCG month on month and still continuing to do so.

  1. Use the OPTIMISE electronic system to prompt the use of UTI template before prescribing antibiotics for UTI in the following instances to ensure its use
  2. a) Trigger: Patients aged 65 years and over, without an uncomplicated urinary tract infection recorded within 1 day, prescribed either trimethoprim without another valid indication (acute pyelonephritis within 22 days or acute prostatitis within 35 days) or nitrofurantoin.

Message Nitrofurantoin or trimethoprim: prescribed without a recorded lower urinary tract infection in patients aged 65 years or overReview use of nitrofurantoin or trimethoprim without a recorded indication; complete the “LLR suspected UTI template in over 65yrs” before prescribing an antibiotic.

  1. b) Trigger : Patients prescribed with a urinary tract infection within 1 month, without a recorded midstream urine sample within 1 month, previously prescribed nitrofurantoin or trimethoprim within 1 month, prescribed either trimethoprim without another valid indication (acute pyelonephritis within 22 days or acute prostatitis within 35 days) or nitrofurantoin.

Message: Nitrofurantoin and trimethoprim: second course for a urinary tract infection prescribed without a midstream urine sample Review repeated use of trimethoprim or nitrofurantoin without a recorded midstream urine sample for a urinary tract infection.

  1. Host the UTI diagnosis & prescribing guidance and UTI resources in a popular website without firewalls accessed by prescribers and care home staff to enable easy and extensive use.

How is the project to be developed in the future?:

Continue improving the UTI diagnosis template in the elderly based on feedback Now that all the resources are available on the website where the various documents in relation to UTI are hosted to liaise with the Health Informatics team to incorporate this in the UTI template and including adding this ( leaflets given to patient)  to the patient record .

All : https://www.lmsg.nhs.uk/guidelines/health-community/genito-urinary-system/

Specifically :

  • UTI care home assessment tool : https://267lv2ve190med3l1mgc3ys8-wpengine.netdna-ssl.com/wp-content/uploads/2018/02/LLR-CCG-UTI-Care-Home-Assessment-Tool.pdf
  • UTI hydration tips : https://267lv2ve190med3l1mgc3ys8-wpengine.netdna-ssl.com/wp-content/uploads/2018/02/hydrationposter.pdf
  • UTI prevention : https://267lv2ve190med3l1mgc3ys8-wpengine.netdna-ssl.com/wp-content/uploads/2018/02/LLR-CCG-Preventing-UTI-poster.pdf
  • UTI to dip or not to dip : https://267lv2ve190med3l1mgc3ys8-wpengine.netdna-ssl.com/wp-content/uploads/2018/02/TDONTD-Leaflet-2018.pdf
  • UTI ;treating your infection leaflet for women outside care homes : https://267lv2ve190med3l1mgc3ys8-wpengine.netdna-ssl.com/wp-content/uploads/2018/02/RCGP-UTI-Leaflet-FOR-WOMEN-OUTSIDE-CARE-HOMES-ENGLISH.pdf
  • Urine symptoms in men fact sheet : https://267lv2ve190med3l1mgc3ys8-wpengine.netdna-ssl.com/wp-content/uploads/2018/02/RCGP-Fact-Sheet-Urine-symptoms-in-men.pdf

Use this system to build other template along with patient information leaflets and read codes for prescribers to follow e.g. FeverPain template.

 

Semex UK

Provide a brief overview of your project:

Thanks to research pioneered in Canada by Dr Bonnie Mallard and Semex, identification of dairy cattle with higher immune response (as in: cattle less likely to suffer disease to the extent other cows do, or not at all), is now a reality. High Immune Response (HIR) technology is a testing method patented in the United States and Canada that enables cattle with inherently superior immunity and enhanced disease resistance to be reliably identified. When such animals are challenged by a bacteria or virus and don’t show signs of illness, or because of their immune response genetics, they get over an infection quickly compared to others, hence considered to be naturally healthier. They individually require less attention and intervention, and at the herd level, the overall potential risk of antibiotic use is reduced. It has also been confirmed that HIR cows are able to provide a proportional concentration of a specific antibody to their calves through colostrum to protect against disease.

HIR testing involves 2 evaluations:

  1. for antibody-mediated immune response (AMIR) and
  2. for cell-mediated immune response (CMIR).

Semex now selects the top 10% of HIR-tested bulls and markets their semen under the brand name ‘Immunity+’ in 120 countries around the world.

Cite 3 examples within the project which highlight promotion of the protection of antibiotics?:

Immunity+ genetics offer producers the ability to select sires who will provide disease resistance to a broad range of pathogens, both bacterial and viral in nature. Opting for sires with disease resistant genetics has paid off for dairy producers around the world. In North America, over 30 herds comprising ~35,000 cows and ~75,000 heifers were analyzed for disease reductions (Larmer et al., 2017). It was found that Immunity+ sired animals had anywhere from 2%-20% less disease (depending on which disease was analyzed). The most significant reductions in this dataset were found in the traits with the biggest economic impacts, including a 20% reduction in cow mortality among the Immunity+ sired animals. In large dairies through the middle east, a 14% reduction in Mastitis was found across over 15,000 cows. Reductions in disease incidence have also been shown in herds across Europe, South America and Asia.

One of the keys to the effectiveness of Immunity+ is a high heritability. By testing the direct immune response capabilities of sires, much of the environmental variation is removed, leaving only the genetic component of disease resistance. At 30%, the heritability of Immunity+ is similar to that of milk production, a trait that has seen enormous genetic progress leading to a 13% increase in per cow milk production in the last 10 years. When we compare the heritability of Immunity+ to other health traits such as Productive Life, we see a significant increase, as much of the variation affecting most health traits is due to environmental and management effects, not differences in genetics. This doesn’t mean, however, that progress can’t be made by selecting on lower heritability traits, but balanced selection on traits with higher heritability, and ultimately, higher reliability, will lead to greater genetic, and ultimately economic progress and lower antibiotic usage.

How is the project to be developed in the future?:

Future research in  evaluating proteins such as natural antibodies and other factors in cows’ colostrum that may impact calf health. As the project proceeds, HIR technology in the short term is enabling more and more dairy farmers to be better informed about their animals, particularly which ones need more attention in terms of their health. More efficient and effective management of a growing number of dairy herds will follow, through housing modifications, vaccination, culling, breeding and so on, leading to improved overall reduction in disease and reduced need for antibiotic use. Long term, we will achieve improved animal health on a regional, provincial, national and global level, reduce risk of antimicrobial resistance and develop a cohort of animals with superior immune response genetics, animals with a much stronger ability to fight newly-emerging or re-emerging diseases.  A genomic test which will provide dairy farmers with an Immune Response score for their cows and calves is undergoing field trials with a launch expected late 2018. The ability to test females for their immune status  will allow us to elevate herd health to a new level.  This will effectively mean that a herd can identify the cows with the best genes for immunity and inseminate them to high-ranking immune sires increasing overall disease resistance and reducing antibiotic usage.

 

UHBristol NHS Foundation Trust (Highly Commended – Antibiotic Guardian Awards 2018)

Provide a brief overview of your project:

We have developed an anti-microbial dashboard tool that displays and reports on the state of anti-microbial prescriptions across all EPMA live areas in the trust in real time.

The dashboard allows visibility to all clinical staff of review dates, indications, cultures and sensitivities, pathology results, course lengths and anti-microbial choice; from any trust PC or laptop. This information is displayed in context so that patients being treated with anti-microbial agents can be prioritised effectively and efficiently according to clinical need.

Cite 3 examples within the project which highlight promotion of the protection of antibiotics?:

  1. Clear display of anti-microbial review dates to all clinical staff (transparency of care)
  2. Clear display, and calculation of, anti-microbial course lengths and durations to inform treatment next steps.
  3. Context links to patient level clinical information including pathology and C&S results to give clinicians quick access to the information they need.

How is the project to be developed in the future?:

Project to be rolled out alongside EPMA system over the course of the next 6 months to all adult inpatient areas.

Dashboard tool is now a key area for benefits realisation for the EPMA project and trust GDE objectives.

The tool has inspired a number of other specialist clinical reporting/dashboard tools.