Antibiotic Guardian Awards 2016 – Winners and Highly Commended

The first inaugural Antibiotic Guardian awards took place on 12th May 2016 to celebrate the work of healthcare professionals across England in tackling antimicrobial resistance. These awards form part of the ongoing Antibiotic Guardian campaign which is led by Public Health England in collaboration with UK devolved administrations and professional bodies.

The evening was attended by healthcare organisations across England who had all submitted entries and then shortlisted for their achievements in work to help combat antibiotic resistance and protect antibiotic usage. Awards were given in the following categories: Community Engagement, Stewardship, Innovation, Collaboration, Prescribing and Research and Staff Engagement and jointly presented by Deputy Chief Medical Officer for England, Professor John Watson and Dr Diane Ashiru-Oredope (lead for the Antibiotic Guardian campaign and Pharmacist Lead for the AMR Programme at Public Health England)

Dr Diane Ashiru-Oredope, Lead for the Antibiotic Guardian campaign, said:

“The Antibiotic Guardian awards are an excellent opportunity for us to champion organisations and individuals who have supported the Antibiotic Guardian campaign and demonstrated achievement in their work to tackle antimicrobial resistance, one of the biggest global public health threats we face.

“These awards have highlighted the wealth of fantastic work taking place across the country in combating antimicrobial resistance. I’d like to personally congratulate all the nominees and winners for their contributions.

“At Public Health England we will continue to support and work with partners across the health system to improve antimicrobial prescribing and stewardship programmes.”

The winners and highly commended entries were:

Collaborative stewardship activities
Winner – Calderdale CCG, Greater Huddersfield CCG, North Kirklees CCG, Wakefield CCG, Community Pharmacy West Yorkshire, Kirklees and Wakefield Council Infection

The four neighbouring CCGs across South West Yorkshire worked in partnership to develop Antimicrobial Guidelines for use in Primary Care. A multi-disciplinary/multi-organisation working group was formed in April 2015 with the remit of developing an antibiotic campaign to reduce unnecessary prescribing of antibiotics. All four CCGs have made significant reductions in the last few years in the volume of Cephalosporin and Quinolone antibiotics used and have managed to maintain levels well below the England average for over two years.

The CCG’s have also carried out a great amount of public engagement, including a live radio broadcast was aired on European Antibiotic Awareness, in which 62 messages came in during the first hour of the show and the broadcast was recorded on the radio YouTube channel and has been viewed 481 times to date, with the station receiving more broadcasts to be delivered like this in the future.

Highly Commended – Berkshire Healthcare Foundation Trust

This mental health and community health services Trust has developed and introduced a number of resources, including the smart phone app the Microguide, and a bespoke e-learning module. The app was launched and promoted using a variety of methods, including computer screensavers during the week leading up to EAAD, a pharmacy team promotional video-clip of the team supporting Antibiotic Guardianship, promotional stands across all trust hospital sites in the county, face to face education sessions at ward level for all clinical staff. A trust-wide re-audit of inpatient prescription was carried out after the interventions above were made and the results showed significant improvements in most standards audited, with 2 out of 8 standards being 100%.

Community
Winner – Devon County Council, Northern Devon Healthcare Trust, New Devon CCG

Devon County Council Public Health led a partnership with North East West Devon Clinical Commissioning Group, Northern Devon Healthcare NHS Trust and the Devon Local Pharmaceutical Committee to develop a pilot social marketing intervention aimed at low income parents to reduce demand for antibiotics.

The project took a different approach to reaching the community and this was dictated by the parents

themselves with the focus groups.

Parents were driven by digital advertising and social media to the video on the Childrens Centre Facebook page and YouTube and Listen to your gut linked up with the Public Health England Antibiotic Guardian campaign to capitalise on national coverage in the lead up to European Antibiotic Awareness Day on 18 November. YouTube pages were linked and the online traffic peaked during this time.

The evaluation in 2014 showed:

Approximate 20% reduction in the prescribing of amoxicillin suspension.

The listen to your gut message resonated with 8 out of 10 participants with over 30% increase in knowledge.

Confidence to talk to a GP increased by one third. Participants associated their increased confidence with the knowledge of length of time and appropriateness of continuing to use paracetamol and water.
In real terms, the campaign delivered an additional 71% animation views, 5% game plays and 78% Facebook page likes. In 2015 the listentoyourgut.org.uk was developed and the video views exceeded 26,000.

Highly Commended – NHS North Kirklees CCG

In the summer of 2015 a new Pharmacist joined the North Kirklees CCG Medicines Management team use his contacts in the area to facilitate and deliver educational sessions the community, including in the local mosques.

He met with the antibiotic project group and put forward a proposition that he would:

Some of the outcomes of the project include:

Two presentations being presented to the students, staff and community surrounding the Institute for Islamic Education which were attended by approximately 350 people. The presentations had a general winter campaign theme, but largely focused on antibiotic use, antimicrobial resistance and the Antibiotic Guardian campaign.
The delivery of four presentations and numerous ad-hoc conversations at local mosques and community groups.
A radio broadcast that had 300 live listeners and over 550+ viewings of the recording to date.

Innovation
Winner- Southern Derbyshire CCG

A range of interventions were set up by the CCGs including educational meetings for GPs and clinicians; the provision of support materials aimed at empowering avoidance or delayed antibiotic prescribing, where appropriate, and improving patients’ knowledge and confidence in self-management; as well as the production of different treatment guidelines incorporating key messages with evidence, indicating where antibiotics are unlikely to be of benefit.

Some of the outcomes achieved were as follows:

School health assistants were trained to deliver education on antibiotics across 180 primary schools in North Derbyshire as part of the hand hygiene lesson for children aged 7–9 years. The children completed a quiz on antibiotics and also took home items with key messages on the appropriate use of antibiotics

GPs, non-medical prescribers and other clinical staff across Derbyshire were invited to attend education sessions on antibiotic resistance, evidence-based antibiotic prescribing and healthcare-associated infections (HCAIs)

Commissioning for Quality and Innovation Indicators, for antibiotic prescribing, have been developed and used for prescribing by Out of Hours clinicians. These include quality indicators for prescribing of: total antibiotic items (to encourage reducing inappropriate antibiotic use); broad spectrum antibiotic items (to encourage prescribing in line with the Derbyshire Antimicrobial Treatment guidelines); proton pump inhibitors (to encourage prescribing in line with Derbyshire guidance); and anti-diarrhoeal medication (designed to check if patients may have C. difficile infection and arranging a test, as appropriate, instead of prescribing these medicines).

Highly Commended – Imperial College Healthcare NHS Trust/ Imperial College London HPRU

The NIHR Health Protection Research Unit (HPRU) in HCAI and AMR at Imperial College held an Antibiotic Amnesty from Monday 16th November until 20th November 2015.

The Amnesty raised a huge amount of awareness for World Antibiotic Awareness Week and the Antibiotic Guardian programme.

By hosting the stands over lunchtime at 2 of the College’s busiest campuses in addition to organizing coverage on the College and Trust websites, we ensured that a signification proportion of the College’s 14,700 students and 8,000 staff were made aware of these schemes even if they did not participate in the event itself.

The teams manning the stands including Fran Husson a patient/public rep, engaged in over 200 separate conversations with staff and students about antibiotic resistance, what is means to us all and what they can do about it- starting with handing in unwanted antibiotics and pledging to become a Guardian. Fact sheets and other information were handed out to hundreds of people.

The Amnesty saw a range of antibiotics including Amoxicillin, Doxycycline, Phenoxymethylpenicillin, Flucloxacillin and Co-amoxiclav surrendered for disposal including some from overseas. Over 204 people signed up to become an antibiotic guardian.

Prescribing
Winner – Leicester City CCG Medicines Optimisation Team

The Medicines Optimisation Team at Leicester City CCG in 2013 embarked on a journey to join the global project in tackling antimicrobial resistance, locally engaging key stakeholders to lead and establishing robust antibiotic stewardship. Activities included reviewing local antimicrobial policies and guidances, driving the agenda for change in primary care guidance, raising awareness of the guidance, and engaging with patients.

Some of the outcomes achieved:

Audit results showed a wide variation in adherence to the antibiotic formulary. Co-amoxiclav, cephalosporin and quinolones % prescribed against all antibiotic items ranged from 2% to 32% across the practices, with a CCG average of 10%.
A reduction in antimicrobial prescribing volume was shown
The team now have a nominated antibiotic champion in each and every practice that act as a link for CCG at practice level for CCGs to communicate and feedback stewardship aspects
Getting the local council to include in the newsletter for local schools the resources available on the e-Bug website
Presentation titled, ‘antibiotic stewardship’ by a Consultant Microbiologist at a protected learning time session for over 120 City GP’s (18th November, European antibiotic awareness day).
Feature on Radio Leicester breakfast show on 18^TH November

Highly Commended- NHS Nene CCG

The project involved a multifaceted approach to reducing inappropriate antibiotic prescribing in the GP practices within NHS Nene CCG. This work has resulted in improved performance according to the antimicrobial indicators in the Quality premium, with reduction in both overall antibiotic use and specifically, use of co-amoxiclav, cephalosporins and quinolones

Some of the initiatives implemented include:

1) the promotion of the antimicrobial markers within the Quality Premium to GP practices.

2) A 6 month pilot of point-of-care CRP testing in the 7 GP practices with the highest antibiotic prescribing is being undertaken.

3) undertaking audits of co-amoxiclav use by community nurses and podiatrists

4) Sessions on antimicrobial stewardship were delivered to non-medical prescribers across the CCG

5) The development of a prescribing newsletter, which is circulated to GPs, nurses, community pharmacists and the acute trusts

Research
Winner- Community for Open Antimicrobial Drug Discovery (CO-ADD) (The University of Queensland, Australia)

The Australian-based Community for Open Antimicrobial Drug Discovery (CO-ADD) was set up to develop a collaborative pipeline of new antibiotic candidates by mining the diverse chemical space of synthetic chemists around the world.

In 12 months, 35,000 academic compounds have been screened from 88 research institutions in 26 countries, and over 300,000 additional compounds have been promised, showing the successful uptake of the program by the academic community.

They have been involved in running and hosting a panel discussion on the BIO 2016 Convention in San Francisco on panel of key experts to address the critical issue of anti-infective development and the need for global alignment of global anti-infective research and development to the patient, as well as well as running numerous antibiotic resistance events in Australia for general public awareness.

www.co-add.org

Staff Engagement
Winner – University Hospital Southampton NHS Foundation Trust

For European Antibiotic Awareness Day 2015, the UHS antimicrobial stewardship team enlisted the help of our pre-registration pharmacists to promote careful use of antibiotics to staff, patients and visitors to our hospital. We arranged and staffed a stand outside the hospital restaurant, providing information on our local use of antimicrobials and public health messages around appropriate antimicrobial prescribing; we helped 76 people to make their Antibiotic Guardian pledge on the day, using laptops on the stall, and promoted the campaign to many more.
The team also visited wards throughout the hospital, speaking to over 150 clinical staff, using a specially-designed flyer showing how our local prescribing compares to national data, and promoting our local antibiotic guideline smartphone app. The team ran a stewardship-themed crossword competition, as well as a social media campaign on Twitter and Facebook, a poster campaign throughout the Trust, changing all computer screensavers throughout the Trust to carry antibiotic stewardship messages, and presenting on antibiotic stewardship at the Trust-wide Grand Rounds meeting that week.

Highly Commended – Dudley Pharmaceutical Health Team, Dudley Office of Public Health,

Dudley Metropolitan Borough Council

The Pharmaceutical Public Health Team in Dudley under took a key project to engage staff in antibiotic stewardship, by focussing staff and GP member engagement activities.

In January 2016, a key event was held, which was attended by over 100 GPs, and focused solely on antibiotic stewardship.

The event was supported by having a photo booth to enable GPs to make a pledge to become antibiotic guardians and holding a certificate stating that they pledge to be antibiotic guardians. The event also included a Behavioural Change Coach, which focussed on getting the GPs to reflect on their prescribing and to focus on the campaign message of Think SAS! – Start right, offer Advice and Safety net

From the start of October 2015 there have been newsletters and ‘focus on’ document that were sent out to various healthcare professionals, with the addition of an antibiotic audit focussing on formulary adherence.

Each practice was requested to submit an action plan on how they were to improve prescribing of antibiotics and improve adherence to the formulary. The audit and action plan demonstrated an overall 7% increase in formulary adherence following the re-audit of over 3000 patient records and the review of antibiotics prescribed

Stewardship
Winner – North of England Commissioning Unit

North of England Commissioning Unit have been successful in developing an accessible toolkit of antimicrobial prescribing resources and interventions to support doctors, nurses, OOH services and other primary care clinicians in the rational use of antibiotics across the North East and Cumbria.

As a result of the numerous interventions, some of the outcomes achieved include:

The NE&C antibiotic guideline having over 1500 views on the NECS-MO website
In the first month of the ‘MicroGuide’ smartphone app being developed, it had been downloaded by over 600 clinicians, and accessed more than 1000 times.
The launching of a public campaign, which reached 1.38m people in the North East, prompting behaviour change in 43% of those surveyed

Highly Commended – Derby Hospital NHS Foundation Trust

The Trust has been successful in developing a Respiratory Infections Team based in the acute admission areas, which reviews all adults admitted between Monday and Friday with suspected community-acquired pneumonia. Point-of-care microbiological testing for influenza PCR and urinary pneumococcal and legionella antigens was possible in 93% of appropriate patients. To date, 43% of patients reviewed by the service have had a positive microbiological diagnosis made, which has led to the admitting medical teams streamlining antibiotic regimens in 19%. As results are generated within the acute admission areas, there has also been a reduction in the time taken for a microbiological diagnosis to be made, allowing an appropriate targeted antibiotic to be chosen early in the admission episode.

The service has also been valuable in providing a rapid influenza diagnosis, which has enable IPC teams to make rapid decisions as to whether patients need isolation and respiratory viral precautions

Gratitude to 4AllofUs who organised the Awards on our behalf.

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The second Antibiotic Guardian awards will be hosted in 2017