David Oliver Hamilton

Why are you nominating them for this award? Please provide clear reasons/evidence of how the person has excelled in delivering antimicrobial stewardship quality improvement.

Dr Hamilton spent last year volunteering as an internal medical doctor in Masanga Hospital, a non-governmental, rural district general hospital in of Sierra Leone. Whilst in this post, he was concerned with the anti-microbial prescribing practices of the junior, national staff so he designed and implemented a quality improvement project on improving anti-microbial use.

Sierra Leone has recently from a prolonged civil war and then from an epidemic of Ebola, and this is reflected in its healthcare system, regarded as one of the least developed in the world.

Antibiotic stewardship in low-income and middle-income countries (LMICs) faces even more challenges than in the developed world and is therefore a very important front of the global fight against antibiotic resistance, and yet there is a comparative paucity of initiatives and research in LMICs.

Dr Hamilton single-handedly wrote a 15-page antimicrobial guideline over the course of two months using a variety of sources, including: MSF guidelines; the BNF; draft antibiotic guidelines from the tertiary referral hospital in the capital, Connaught Hospital in Freetown; the website UpToDate; and discussions with Consultant Microbiologists based back in the UK. These guidelines were collated and adapted to the local setting based around drug availability and cost. They were comprehensive covering 54 different diagnoses with 31 different antimicrobials.

He then implemented these guidelines and tested their effectiveness, whilst at the same time running individual and small-group teaching sessions on the importance of antibiotic stewardship.

It is largely because of this project that a proposal for a microbiology laboratory has been made for this hospital.

More about this project can be found at https://bmjopenquality.bmj.com/content/7/4/e000495.info

Farizan Binti Abdul Ghaffar

Why are you nominating them for this award? Please provide clear reasons/evidence of how the person has excelled in delivering antimicrobial stewardship quality improvement.

Mdm Farizan is a passionate and motivated cardiac intensive clinical pharmacist and antimicrobial stewardship pharmacist leader in Cardiology Centre Serdang Hospital, National Antibiotic Committee.
She leads the cardiothoracic department in Surgical Prophylaxis Quality Project collaborate with cardiothoracic surgeon, cardiothoracic anaesthesiology perfusion department and infection control team. An audit was carried out in cardiothoracic department to evaluate the surgical site infection rate and factors contributing surgical site infections. Among the interventions were standard checklist for cardiac surgery patients were created, staff training for surgeon and staff nurses on patient handling, nasal swab screening for all staffs and patients, appropriate antibiotic choice and duration for surgical antibiotic prophylaxis, referral of patient to wound care team. This project has led to reduce in surgical site infection rate and increase awareness among staff in cardiothoracic department.
She is antimicrobial stewardship pharmacist leader in Serdang Hospital without the infectious diseases physician that involves establishment of AMS committee, antibiotic restricted duration, regular AMS round, established antibiotic chart, enforced carbapenem and polymyxin pre authorization, point prevalence survey and carbapenem order form. This results in increase awareness of judicious use of antibiotic and sharing of successful AMS story in National Antibiotic Conference.
She also actively engaged in National Antibiotic Committee, publication of several guidelines which include National Antibiotic Guideline 2014, promotion of appropriate antibiotic use through live telecast radio and facebook.

Nicola Walker

Why are you nominating them for this award? Please provide clear reasons/evidence of how the person has excelled in delivering antimicrobial stewardship quality improvement.

Nicola has been in her position of Specialist Pharmacy Technician for just under one year. In that time she has demonstrated an exceptional capacity for leadership and quality improvement in relation to antimicrobial stewardship. Examples of her work include determining the best method of oral antibiotic liquid supply to improve the patient experience and reduce the workload on local general practices. Criteria included: patient/carer practicality, risk of error, cost, and staff training. Nicola was able to complete this project successfully and thereby increase the likelihood of appropriate antibiotic use in this patient population. Nicola has also been central to improving the performance of the outpatient parenteral antimicrobial therapy (OPAT) service in the Trust by displaying excellent communication and leadership skills working across sectors. Her eye for quality improvement has led to a standardised list of discharge medications for OPAT, including flushes and diluents, and well as a proactive in-reach service to identify patients eligible for home IV antibiotics. This has led to an increased number of referrals as well as a decreased time to discharge.

Sabiehah Latif

Why are you nominating them for this award? Please provide clear reasons/evidence of how the person has excelled in delivering antimicrobial stewardship quality improvement.

Sabiehah worked collaboratively with the practice nurses and GPs, experienced lead nurse and lead pharmacist to independently deliver some compelling results in a practice  that had never previously managed to adequately reduce their antibiotic usage to reach national threshold maximum levels.
Sabiehah quickly worked out that she had to use her influencing skills  to encourage embedding the CRP machine into practice, visiting them every week, chatting to available staff about their concerns and finding solutions.
We did not use the CRP tests in every patient, but just in those where a low or high result would influence care.
Not all GPs believed the CRP testing would change practice, but the results achieved are compelling, they include increasing use of tests, decreasing antibiotic use and reduction in patient visits.
Sabiehah has produced a high quality report on the outcomes of the work, using various data sources including ePact, excel and local dashboards.  Quietly unassuming she has independently worked with a practice that had not been able to reduce their antibiotic usage to the national standard maximum, despite other attempts and found solutions that fit the practice working ethos.
The practice feel the project was a success and are now hoping to keep their CRP machine (which is rented) because of the embedded culture of use.

Julie Fosbrook / Kettering General Hospital

What category best describes the persons current role: Pharmacist

Why are you nominating them for this award?  Please provide clear reasons/evidence of how the person has excelled in delivering antimicrobial stewardship quality improvement:

Background:

A business case was developed to improve the antimicrobial team employing a band 7 antimicrobial technician following the introduction of the Antimicrobial CQUIN in 2016/2017 to improve antibiotic stewardship (AMS).

Objectives:

To improve antimicrobial stewardship (AMS) across all areas of the trust,  to achieve the antimicrobial CQUIN (3/5 predicted with investment) and increase team resilience.

Method:

An experienced technician with established networks across the Trust was employed. Work streams were identified from the organisation’s Antimicrobial Stewardship Programme linked to 4 themes:

• Clinical leadership
• Education
• Guidelines
• Accessibility of guidelines and antimicrobial team

Results:

There are three sections of development and implementation:

Antimicrobial technician roles:

Guideline updates and development eg  penicillin allergy

Patient information leaflets

Population of app to improve guideline accessibility

AMS ward rounds

Development of Audit plan, data collection, collation and feedback

Team resilience:

Support for sepsis work stream

Reliable delivery of AMS training by increasing team capacity

CQUIN data collection

Antimicrobial newsletters

Ward visits promoting guideline changes and new antibiotics

Antimicrobial pharmacist role expansion:

Time released for new workstreams and clinical leadership

Business case development

Pharmacist led outpatient clinic for initiation, monitoring and supply of IV antibiotics including 24 hour infusers

Guideline review and  development.

CQUIN tracker

Conclusions:

The appointment of Julie, a proactive experienced band 7 pharmacy technician to the AMS team has improved delivery of a robust AMS programme resulting in increased trust engagement. Importantly the antimicrobial pharmacist has been released for clinical leadership and service development. Improved input to education and training has resulted in more knowledgeable, engaged and empowered trust staff and enhanced awareness of and participation in AMS  improving patient care. The trust achieved 3 out of 5 antimicrobial 2016-17 CQUIN indicators 2016/17.

Mulu Assfaw / London North-West University  Healthcare NHS Trust

What category best describes the persons current role: Nurse

Why are you nominating them for this award?  Please provide clear reasons/evidence of how the person has excelled in delivering antimicrobial stewardship quality improvement:

Antimicrobial resistance is a major global health threat, requiring a multidisciplinary approach in antimicrobial stewardship (AMS). However  studies (1) (2) demonstrate lack of AMS knowledge and engagement amongst nurses, the largest NHS workforce group.

As a member of a nurse practice group (NPG) Mulu Assfaw identified and challenged poor practice (high risk of MRSA resistance among ITU patients, due to routine daily prophylactic use of Bactroban). Using a literature review of evidence-based practice, she raised her concerns and consequently the Trust’s routine use of Bactroban was stopped, unless patients are MRSA-positive.

Recognising nurses’ low AMS knowledge and engagement, Mulu successfully launched a Trust-wide Antimicrobial Stewardship Campaign, with colleagues’ support, to create awareness of AMS and to actively promote nurses and other healthworkers to be antibiotic guardians. Her success as project initiator and leader is recognised and in 2017 she won the Trust Staff Excellence Award in Patient Safety and was a finalist for the Nursing Times Award. Her initiative focuses on educating nurses about antimicrobial resistance, empowering them to actively engage with the AMS programme and she continues to positively influence team practice and performance in infection prevention and control throughout the Trust.

Mulu strongly believes that a longer-term solution is needed, based on cultural change, leading to the reduction of antimicrobial use worldwide. In order to sustainably engage our future workforce she is embarking on research to identify current levels of AMS knowledge, understanding and attitudes in final year nursing and midwifery students at a London-based university. This is greatly welcomed by the university as the results will inform the development of AMS education to meet the learning needs of future nurses and midwives. Mulu intends to utilise the experience and results gained from the initial research to encourage other universities to incorporate AMS education into their curricula.

1. McEwen J. and Burnett E. (2017) Antimicrobial stewardship and pre-registration student nurses: Evaluation of teaching. Available at https://www.nursingtimes.net/
2. Olans R.D. et al. (2015) Defining a role for nursing education in staff nurse participation in antimicrobial stewardship J Contin. Educ. Nurs. 2015 46 7 318–21 Available at https://www.ncbi.nlm.nih.gov/pubmed

Ryan Hamilton / University Hospitals of Leicester NHS Trust (Highly Commended - Antibiotic Guardian Awards 2018)

What category best describes the persons current role: Specialist Pharmacist – Antimicrobials

Why are you nominating them for this award?  Please provide clear reasons/evidence of how the person has excelled in delivering antimicrobial stewardship quality improvement:

Ryan took the initiative to contact the Leicestershire Scouts Head Quarters to implement an infection educational session with Scouts, Cubs and Beavers within Leicestershire and link these activities to the children obtaining an Antibiotic Guardian badge. Ryan produced a training pack which we have distributed to all scout leaders across the county and organised train the trainer sessions so that scout leaders could learn about the educational activities and key infection prevention messages in order to carryout similar teaching in their local scout huts. This initiative has led to many children within Leicestershire learning about hand hygiene, transmission of infection at a basic level and the use of antibiotics for bacterial infections.

Ryan set up AMS ward rounds on the admission wards at the University Hospitals of Leicester NHS Trust (UHL) that included a grand round teaching session to share results of the ward rounds with medical clinicians and enable them to learn from key interventions. The results of these ward rounds were shared at an AMS workshop at a national conference.

Ryan also led on a quality improvement project to increase the influenza vaccination rate within the pharmacy department at the UHL. Through the monitoring of vaccination uptake rates via our occupational health department, it was clear that the pharmacy department had the lowest uptake rates of the vaccine compared to other areas. Ryan enlisted the support of a pre-registration pharmacist to prepare a questionnaire to determine the reasons behind pharmacy staff refusing to be vaccinated. The results from the audit have been used to highlight areas for development within the occupational health vaccination campaign and also areas for the pharmacy department to improve; such as education, key messages to pharmacy staff and a pharmacist peer vaccinator.

Sarah Drake / Leeds Teaching Hospitals NHS Trust

What category best describes the persons current role: Junior Doctor

Why are you nominating them for this award?  Please provide clear reasons/evidence of how the person has excelled in delivering antimicrobial stewardship quality improvement:

I am passionate about antimicrobial stewardship and improving antimicrobial prescribing in Leeds Teaching Hospitals. I have utilised quality improvement methodology to try and improve clinical review of intravenous antibiotics working with medical, nursing and pharmacy staff on two medical wards.

In 2015-16 I undertook a quality improvement project that highlighted inadequate or absent “day 3 reviews” on medical wards.  There appeared to be several factors that contributed to this and I felt the situation would not be improved by single interventions directed towards antimicrobial prescribing and a multifaceted approach would be required.

Before implementing any interventions I carried out a project to understand the barriers to undertaking day 3 reviews. I developed a questionnaire using the Theoretical Domains Framework to try and identify behavioural factors related to day 3 reviews and distributed this to medical, nursing and pharmacy staff on two acute wards. The questionnaire assessed 11 different barriers that might prevent behaviour change. I also observed handover and ward rounds on the two wards to compare actual clinician practice with results from the questionnaires to help identify further areas for potential improvement.

The results of the questionnaire suggested that multiple barriers existed to undertaking  day 3 reviews. These included poor written and verbal communication between staff; inadequate or infrequent training; limitations in the daily functioning of the wards and presence of medical emergencies or other incidents. These results matched observed practice.

I am currently undertaking “Plan, Do, Study, Act” cycles to determine which interventions are likely to have a positive impact on reviewing antimicrobials. I am particularly focussed on communication between staff and improving the systems involved in the daily functioning of the wards (especially handover and identification of patients requiring review). If these interventions demonstrate an improvement I will extend these approaches to other wards in the hospital.