Shared Learning 2020: Innovation and Technology

Projects that demonstrated innovative approaches to tackling antimicrobial resistance

2020 Entries

Manchester University NHS Foundation Trust and University of Manchester

Provide a brief overview of your project?
Aims

Produce a practical training package which applies behavioural science to antimicrobial stewardship (AMS)
Create a cohort of AMS champions, in the City of Manchester, who are experts in behaviour change related to antimicrobial resistance (AMR) and stewardship with the capability, opportunity and motivation to drive change in practices related to AMR and AMS.

This project is a collaboration between the University of Manchester, Manchester University NHS Foundation Trust and Manchester Health and Care Commissioning and was funded by an AMR innovation grant for HEE.

Objectives

Create the “Behavioural Approaches to AMR” course: a one-day training course for behaviour change related to AMS/AMR.
Create the “Training in Behavioural Approaches to AMR” course: a one-day train the trainer module to create trainers who can teach the Behavioural Approaches to AMR course.
Create the trainers: 29 healthcare professionals from across primary and secondary care in the City of Manchester undertook the 2 day training to become AMS master trainers. (Doctors, pharmacists, pharmacy technicians and specialist nurses.)
Create the AMR champions: Each newly trained trainer will identify 10 health care professionals and prescribers in their local area to attend the “Behavioural Approaches to AMR” course. Health care professionals attending the “Behavioural Approaches to AMR” course will then act as an “AMR Champions”.
Evaluate the process of identifying, training and certifying the trainers through a qualitative process evaluation and collection of robust behaviour change feedback.
Create a behaviourally-informed evaluation, which the newly trained trainers will be able to use to monitor their own behaviours and the impact on behaviours in their local environment.

We have currently achieved up to objective 3, and our AMR master trainers in Manchester are implementing the AMS Champion training in their local areas. Evaluation will follow in the next phase of the project.
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.

Creating a network of AMS master trainers and AMS Champions across the City of Manchester will enable healthcare professionals to:

Understand why we need to improve AMS.
Explore influences of behaviours
Develop interventions to change behaviours.
Talk to people about their behaviours.

Employing the behavioural approach above will strengthen AMS practices within Manchester which will have a positive impact on AMR.
The Tackling Antimicrobial Resistance Action Plan 2019-2024 identifies three key objectives for tackling AMR. These are (1) reducing need for, and unintentional exposure to, antimicrobials; (2) optimising use of antimicrobials; and (3) investing in innovation, supply and access. Using our behavioural approach we will improve antibiotic prescribing primarily by reducing the number of antibiotic prescriptions in patients not requiring antibiotics (both those patients without infections and shorter course lengths). This strategy will address the first two objectives published in the five year plan.
How is the project to be developed in the future?
This project is very much in the implementation stages and more evaluation is to come.
The AMS Change development team hope that the practical training material can be adopted by other teams and used to coordinate similar behaviour change AMS training packages in areas across the UK. The training materials have already been utilised by the Royal Pharmaceutical Society in AMS training, and in Jinja Uganda by one of the CwPAMS teams.

Makerere University School of Public Health

Provide a brief overview of your project?
Nottingham Trent University (NTU), UK in partnership with Buckinghamshire Healthcare NHS Trust (BHT), UK, Makerere University, Entebbe Regional Referral Hospital, and the Ministry of Health have established two online Communities of Practice (COPs) on antimicrobial stewardship (AMS) one for students and another for health professionals in Uganda. The health professionals COP is hosted by the Ministry of Health National Technical Working Committee (TWC) on Antimicrobial Stewardship (AMS), Optimum access and use (ASO) and it is delivered via Google Groups. This COP is a platform for knowledge exchange, sharing opportunities, and co-learning in Uganda and beyond. Membership to this platform is open to any individual with an interest in AMS and Antimicrobial Resistance (AMR) including health professionals, researchers, implementers, policy makers, academics and the general community. This platform is geared towards improving AMS which is in line with the Uganda AMR National Action Plan.

Students for Antimicrobial Stewardship COP is a Facebook group that was formed after the realisation of the need for students to work together, in a multidisciplinary setting at an early stage to tackle AMR. The main objective of the COP is to provide a platform for students to engage on AMS/AMR issues. This platform is managed by five AMR champions from Makerere University from multidisciplinary courses. The AMR champions are from: School of Veterinary Medicine; School of Biosecurity; Biotechnical and Laboratory science; School of Health Sciences; and School of Public Health.

These COPs are supported by a project titled “Strengthening Antimicrobial Stewardship in Wakiso district”. This project is funded by the Commonwealth Partnerships for Antimicrobial Stewardship Scheme (CwPAMS), an initiative of Commonwealth Pharmacists Association (CPA) and Tropical Health and Education Trust (THET) under the Fleming Fund of the UK Department of Health and Social Care (DHSC).
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.
A network of vibrant individuals passionate about AMR has been established in Uganda and UK. Currently, the students’ COP “Students for antimicrobial stewardship” has 71 members while the health professionals COP, “Antimicrobial Stewardship, Optimum Access and Use in Uganda” has 157 members, and membership of these groups is steadily increasing.

There has been growth in leadership and management on both platforms. The 5 AMR champions managing the students’ COP have assigned roles to other members and sent out invitations to interested students. Students on the team have also identified opportunities to share their knowledge on AMS such as seminars, conferences, primary and secondary schools, and community outreaches. This is also the same with the health professionals COP as the team leads from the Ministry of Health Uganda and Makerere University work hand in hand to avail resources on the platform.

Numerous resources and materials have been shared on the two COPs. The health practitioners’ COP has sent out over 40 emails with resources, opportunities, and other materials concerning AMS / AMR from Uganda and globally. The students COP has sent over 20 messages on opportunities for students to take part. Resources shared include: Welcome Trust’s report on reframing AMR; the Uganda National Action Plan on AMR; conferences; MOOCs on the role of diagnostics in AMR; future learn packages for antimicrobial Stewardship in Veterinary Practice and a social science course for tackling AMR; post – doctoral positions AMR on farms; and published articles on AMR from WHO and researchers. Members of the COPs are very much appreciative of the materials shared and have been seen to apply for some conferences, job opportunities and online courses. For example 3 members of the health professionals COP submitted abstracts to the 4th Uganda National conference on AMR 2019, and BSAC conference 2020.
How is the project to be developed in the future?
We plan to have webinars and workshops among members of the COP to explore collaborative ideas on achieving the 5 pillars of the National Action Plan on AMR. We are also exploring involvement of other key stakeholders such as Ministry of Agriculture, Animal Industry and Fisheries, Non – Governmental Organisations such as Infectious Diseases Institute (IDI) and other universities in the UK as members of the COP.

Great Ormond Street Hospital for Children

Provide a brief overview of your project?
In April 2019 Great Ormond Street Hospital adopted a Trust wide electronic patient record (EPIC) including a new laboratory information system (Beaker). This was a huge project which came with huge opportunity. The AMS team were proactively embedded in the team building the new EPR system which allowed bespoke AMS modules to be created which have provided unique opportunities improved AMS interventions. We developed the following specific AMS modules (see attached document):

AMS ward round templates to document all interventions in line with the Start Smart then Focus principles
Quick reference AMS report which can be seen for each patient giving a snap shot overview. Within this it shows bug-drug mismatches, de-escalation recommendations, IV-PO switches, lines, and days of therapy
Patient specific antibiogram data which compares bug-drug combinations in a format that can be seen over time
Patient specific lists vital for continue effective handover
Specific lists to identify all patients currently on restricted antimicrobials as set by the AMS team – meropenem, piptazo, amikacin, antifungals
Real-time hospital wide antibiogram using a feed from EPIC/Beaker to produce a web-based platform to display results (including last 20 years of previous microbiology data)

Please cite 3 examples of outcomes or impacts from the project on tackling AMR.

The AMS ward round bespoke templates are generated during every ward round interaction which goes into the patient notes. These can be searched and filtered by the clinical teams so they can easily see the recommendations. We are able to easily audit our interactions and monitor activity, for example in last 6 months (Aug2019 –Feb 2020) we made 1276 AMS round documentations.
The AMS report is available to our clinical colleagues and also give suggestions to mismatches between organism susceptibilities and current antimicrobial therapy which can highlight potential areas to maximize treatment options.
Specific antimicrobial lists and hospital wide antibiogram allow us to target interventions such as reduction of broad spectrum antibiotics and also horizon scan for increases in resistance rates that may lead to changes in either treatment or prophylaxis guidelines

How is the project to be developed in the future?
There are many components to the project allowing us to develop different avenues for the future, for example:

The Trust wide antibiogram will be presented regularly at both the antibiotic policy group and antimicrobial stewardship committee meeting to highlight areas of concerns which can then be used for implementation any changes needed to policies/guidance. We have already used this to help implement antifungal drug switches.
The AMS rounds and interventions will continue but now we can audit the process and activity we can see where we can target resource in the future to improve efficiency
Rapidly identifying patients on broad spectrum antibiotics or patient’s who could be stopped/changed/de-escalated should help target our aim to reduce antimicrobial usage across the Trust.

Nottingham Trent University

Provide a brief overview of your project?
We used Skype, social media and other technology creatively to engage university students and facilitate awareness raising about antimicrobial resistance (AMR) and antimicrobial stewardship (AMS) in the UK and Uganda “without borders”. We delivered lectures and Q&A sessions to Microbiology students from Nottingham Trent University, UK (NTU), and Environmental Health students from Makerere University School of Public Health, Uganda (MakSPH). The students were then invited to compete to produce the best comic strip, song or short video to raise public awareness of AMR and how to help in the fight against AMR.

Students at NTU were supported with resources supplied via the university’s Desire2Learn-based online learning platform and via email, while students at MakSPH were supported using an emailed slide set with voiceover and a Q&A session delivered from NTU via Skype.

We ran a “Global perspectives on AMR” event during World Antibiotic Awareness Week in November 2019, held simultaneously at NTU and MakSPH with the two classrooms linked up using Skype and projector screens. The winning competition entries were shared and a prize-giving ceremony was conducted, supported by the academic teams of each university. Discussion between the UK and Uganda students allowed them to exchange perspectives on the global AMR problem. NTU students were then linked via Skype to Antimicrobial Pharmacists at Buckinghamshire Healthcare NHS Trust for an “ask a pharmacist” session to find out more about AMR and AMS in UK hospitals.

Highlights of the event and winning competition entries were shared on social media (Facebook and Twitter). The students produced outstanding entries including a very catchy song about how to fight antibiotic resistance, and a gripping video dramatization of the development and outcome of a serious antibiotic resistant infection in Uganda, and how this could have been prevented.
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.
The winning competition entries submitted by the students are suitable for use with other university students and with the general public, to promote awareness of AMR and how to help prevent it. In particular, one group of MakSPH students produced a very powerful video dramatization that started with inappropriate sale of antibiotics for daily use by a schoolgirl at home, through her hospitalisation with a life-threatening antibiotic resistant infection, to the lessons learnt at the ensuing court case. Another student produced a very catchy song offering simple advice to farmers, doctors and the public to help stop antibiotic resistance, with key messages repeated in both English and Lugandan.

By participating in the competition, students’ knowledge and understanding of AMR, AMS and infection control measures was improved. We received very positive feedback from participants, who found the Skype-mediated discussions very thought provoking. The competition entrants also developed their communication and team working skills, and the winners received certificates and acknowledgements which will enhance their CVs.

Running the event increased the knowledge and understanding of all participants, including the academic facilitators. Having the opportunity to link up with students in a classroom 4000 miles away was a unique experience for everyone involved. We all learnt more about the shared challenges, different perspectives and common approaches we can take to tackling AMR by participating in this joint UK-Uganda event.
How is the project to be developed in the future?
We intend to make this an annual event and increase the number of student participants over time. The future winning entries will be further publicised, and we hope to make more extensive use of these outstanding student-generated resources in our ongoing outreach and training activities. We would also like to extend the collaboration between our two university departments now that this link has been established, for example by running joint UK-Uganda student research projects.

JAMII MEDICAL AWARENESS(JMA)

Provide a brief overview of your project?
Jamii Medical Awareness (JMA) project aims at fighting the emergence and spread of Antimicrobial Resistance (AMR) in Tanzania and beyond the borders by creating a society with proper education and awareness on Antimicrobial resistance.

The project’s main purpose is to educate on proper use of Antibiotics, increase awareness on Antimicrobial resistance and bring about Behavioral Change to the community towards curbing antimicrobial resistance.

Jamii Medical Awareness in November 2018 officially launched TABASAMU LA TIBA SAHIHI Campaign which translates in English as THE SMILE OF PROPER TREATMENT,the campaign has been conducted for a period of one and a half year.

TABASAMU LA TIBA SAHIHI is the DIGITAL-ART campaign launched to complement the efforts of WHO and the Tanzanian Ministry of Health’s Action plans on the number one strategic step of dealing with Antimicrobial resistance which is to increase the awareness and subsequently to effect behavioral change in the society on proper use of Medicines.

The campaign hence is the Awareness campaign with the long term plan of enabling the society to change their behaviors on how they deal with Antimicrobials and hence slows down the rate of AMR emergence.

With about 43% of Tanzanian population being able to access digital services. And the number of people who seek for entertainments in communication channels being the majority, came up the idea of using entertaining contents in reaching the society. The biggest reason for AMR rise is our behaviors on improper medication. And since Arts play a big role in penetrating the walls of societal behaviors, JMA hence prepared snippets of drama video and songs.

JMA has been using platforms like Social Media, Radio, Television, Magazines, Community awareness events and Community outreaches to spreads AMR awareness Education using Digital Art contents.

JMA currently uses 3D animation series called TABASAMU LA TIBA SAHIHI.
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.
1. Reaching the Local community physically.
JMA has participated in more other ten scientific conferences, symposiums and workshops for the year 2018-2019.
JMA exhibited its contents at the Muhimbili Univetrsity World Antibiotic awareness week workshop organized by Tanzania Pharmaceutical students’ association November 2018 with about 200 attendees. In June 2019 JMA attended Tanzania Pharmaceutical Student’s association scientific conference in Zanzibar and presented the campaign to about 500 attendees. In September 2019 JMA attended the Kairuki Scientific conference and presented to about 200 attendees. In November 2019 JMA, again participated at the Muhimbili University World antibiotic awareness week organized by Tanzania Pharmaceutical students’ association with about 500 attendees. JMA so far, has done physical outreachs in Health and Education institutes in Dar es salaam,Mwanza,Dodoma,Morogoro and Ruvuma regions in Tanzania.

2. Reaching the local community through media.
All the educative contents created by JMA were disseminated through JMA’s social media platforms mainly YouTube, Instagram and Twitter to reach the community. On the other hand JMA disseminated AMR education via Main stream media including Radio and Televisions for instance JMA we have been having a Four months program at Clouds Media since July 2019 to November 2019 and through that session, JMA has managed to reach over 5 Million.JMA carried out AMR awareness sessions with other Media houses with national and regional coverage including Mwananchi Communications Limited both on their Online Television and The Citizen Newspaper where the campaign was featured several times and reached large number of the public. JMA also carried four hours sessions at Kiss FM Media.

3. Reaching the international community.
JMA has managed to use international media platforms to spread its digital art campaign. JMA did interview with British Broadcasting Corporation (link https://www.youtube.com/watch?v=2hoxYfa5_h4) of and Deutsche Welle (link https://www.dw.com/sw/kwanini-usugu-wa-dawa-unaongezeka/av-52119814 ) which ensured that the campaign crossed international borders.
How is the project to be developed in the future?
Stepped out among the best ten (10) ideas out of 358 innovative ideas from several medical students across the country through the students’ health innovation challenge called “MAWAZO CHALLENGE” in 2017,JMA came up a VISION “To create a healthy society that is free from morbidity, mortality and unnecessary increased costs of treatments associated with disease outbreaks and challenges due to lack of health education and awareness” and a MISSION of “Using campaigns, medical camps, educative physical outreaches and arts to reach out to Tanzanian and international communities with preventive health education, health services and awareness on Antimicrobial resistance” Hence JMA is looking forward to work with local and global partners in creating more variable contents, enabling more dissemination, wider physical and media coverage, and better results.

FADIC “First Arabian Drug Information Centre”

Provide a brief overview of your project?
FADIC Antimicrobial Stewardship E-Learning School Using Mentorship-Reviewer Innovative System.

In 2014, FADIC “First Arabian Drug Information Centre” was launched as a new vision in pharmacy education, with the theme of lifelong learning never stops. In 2017, FADIC Antimicrobial Stewardship E-Learning interactive school: https://fadic.net/school-of-stewardship/, started using the technology, after investigating effective way and innovative techniques to provide an evidence-based stewardship education, using an active learning strategy, such as case-based learning, project-based learning, simulations and roll play model.

The school is divided into 7 modules; ASP Systematic Thinking, Antimicrobial Guidelines, ASP Implementation in Acute Care Setting, Long-Term Care, Ambulatory Care, OPAT, and ASP Strategic/Sustainability Plan.

The complete system is updated technically in 2018, after FADIC joined CDC Antimicrobial Resistance Challenge (AMR Challenge), to promote stewardship education Antimicrobial Stewardship School, established for pharmacists, medical, and nurses.

The use of technology in FADIC Stewardship School with Mentorship-Reviewer Innovative System has an amazing learning cycle, consists of the followings:

Students register to the stewardship through FADIC website
Online sessions on weekly basis, based on FADIC observational study, to assess the best way to teach stewardship.
Workshops are available after each week that need to be answered, in order to make sure that students can apply all what they have learnt in the sessions.
Mentors contact students every week through Mentor Chat in FADIC website, to help them and answer questions. If still need extra mentorship, Electronic 1-to-1 mentorship is used to facilitate any difficulties.
Projects are available at the end of each module are reviewed also, and the results are submitted to the students, either approve or rejects for further modifications.
Mentors and reviewers are with the students till the final project from their work, and introduce the whole projects, in order to be eligible for the final certification.

Please cite 3 examples of outcomes or impacts from the project on tackling AMR.
– The establishing of antimicrobial stewardship e-learning innovative school, after FADIC joined CDC AMR challenge, in this link (F letter):
https://www.cdc.gov/drugresistance/intl-activities/amr-challenge.html#f

– 1st outcome are students, as they learnt how to apply stewardship successfully in their work place, the system is built after investigating best active leaning innovative tool using technology to educate stewardship study presented in ACCP- https://fadic.net/events/fadic-in-accp-updates-in-therapeutics-2018-jacksonville-florida/, the total number of students are 97, and from them 80 were not applying antimicrobial stewardship in their work, after finishing their final project with FADIC, they became able to share in stewardship committee, implement ASP in their work place. Here is the link of published case study in FADIC website: https://fadic.net/case-study-in-implementing-antimicrobial-stewardship-program/ – Additionally, here is the link of the antimicrobial stewardship Initiative: https://drive.google.com/open?id=14u_3zPZHyDSrc2ftte6NpHreMSoo8UW0

– 2nd outcome are Mentor-reviewer system effectiveness, not only for students, but also for mentors, as they became a role model, as they make recording to teach them the effective role of mentorship in their learning system: https://youtu.be/Mx1XaXGSalY, and mentorship-reviewer system policy: https://drive.google.com/open?id=1tBk8-2Ck7JZSgYslojXiPPAwLDgqDj3G – The total number of mentored students were 60 students, as cited here: https://drive.google.com/open?id=1tuCgMZ1qk_duFhrHctRC5JOurXVZv2UM – It builds an antimicrobial stewardship community leader, sample of reviewer reject or approve ASP project: https://drive.google.com/open?id=17MSH-TF3pfzSyzJxxsL4KhlCpTQTdeCj

– 3rd outcome is the quality improvement stewardship projects, as the total number of reviewed projects are 80 projects, that help them after that to apply in their work, either in KSA, Egypt, UAE, Yemen, Qatar and Sudan. Students are able to train all medical staff in the hospitals to apply stewardship properly. They became capable to lead stewardship and make guidelines for ASP for proper empirical therapy selection, and so maintain clinical (DOT, and DDD) resistance, and economic outcomes; optimisation to antibiotic dosing all over the hospital, think in a systematic way in any infected patient, Here is example:
https://drive.google.com/open?id=1kV-RjLp8K5Z7r9-OjMKwhW-m95MVDxqx
Additionally: https://drive.google.com/open?id=1XVPuKbnJkK8NH4Av4QKy_bFOb008sc-a
How is the project to be developed in the future?
The project is targeted pharmacists in the middle east, till now the total number of them was 101 students, the plan is to expand the AMR challenge, through expand the student numbers, mentors, and mentees. Additionally, with increase the public events, online talks and webinars, to increase the awareness, and stewardship researches to provide all updated in antimicrobial stewardship implementations.

Cardiff University, School of Medicine

Provide a brief overview of your project?
Edward Portal has been working for the last 3 years as a PHE-funded PhD student. He has co-invented a new bacterial screening medium that allows for the accurate Antimicrobial Susceptiblity Testing of Legionella spp. He has participated in the patenting process for this medium with his co-supervisors Vicki Chalker (PHE) and Brad Spiller (Cardiff University – nominator in this form; SpillerB@cf.ac.uk) and has been actively supporting commercialisation of the product (LASARUS) to secure licencing agreements with ThermoFisher (UK) and Liofilchem (Italy). This medium is revolutionary through the face that it does not require the presence of activated charcoal in the agar-based medium to enable growth of fastidious Legionella species; therefore, the medium is translucent (not opaque) and allows AST by reading growth through the bottom of the plate (i.e. without having to remove the plate lid and expose the investigator to this respiratory pathogen). Ed has also combined this revolutionary new growth medium with semi-automation with a multipin inoculator so that up to 500 isolates can be screened against 5-dilutions of 8 antimicrobials per day. He has applied this method to over 3000 Legionella isolates archived at PHE (covering the years from 2002 to 2019) to identify a series of isolates that are resistant to rifampacin, azithromycin and ciprofloxacin, which have not been identified in clinical cohorts before.
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.
Edward Portal is a named co-inventor for LASARUS with his supervisors Vicki Chalker (PHE) and Brad Spiller (Cardiff University) and has directly supported the successful patent application: International Patent Application No. PCT/GB2019/052382 for PHE. This support has included manufacturing product test plates for negotiations with ThermoFisher (UK) and Liofilchem (Italy) to market this product commercially world-wide, as well as performing QC for the plate batches and discussing the results performed by the proposed commercial partners. Ed has been invited to 2 international meetings to present his data as an oral presentation on LASARUS on 30th August 2018 in Lyon France at ESGLI 2018 (Edward PORTAL: New high-throughput agar-based Legionella pneumophila antibiotic sensitivity testing method for large scale screening) and on September 12th, 2019 in Athens at ESGLI 2019 (Concordance for MIC Results between LASARUS against Gold Standard Microbroth Dilution Method, while BCYE Gives Elevated and Widely Variable Results. Presenter Edward Anthony Reginald Portal (UK). Based on these activities, Ed is the first author for 2 directly related manuscripts currently under consideration at the Journal of Antimicrobial Chemotherapy: (1) an international position paper giving recommendations for AST unification (Legionella antibiotic susceptibility testing: is it time for international standardisation and evidence-based guidance?) co-authored by authors from every continent and including CDC and EUCAST representation and (2) a definitive concordance comparison proving LASARUS to be superior to other solid agar based methods (Legionella Antimicrobial sensitivity testing: Comparison of Microbroth dilution, BCYE and LASARUS solid media.).
How is the project to be developed in the future?
Edward is currently part of an international consortium aiming to set international breakpoints (none currently exist) for Legionella pneumophila, as well as develop co-operative international projects for large scale screening of archived samples. Edward is also currently reformulating key aspects of the medium to adapt it to other fastidious organisms that do not have reliable AST methods such as Bartonella or to make medium more successful at culturing organisms that only intermittently grow from clinical samples (i.e. Neisseria gonorrhoae). Commercialisation of this product will allow international unity for determining antimicrobial susceptibility for Legionella pneumophila in the near future.

Belfast Heath and Social Care Trust

Provide a brief overview of your project?
In Northern Ireland, the Strategy for Tacking Antimicrobial Resistance (STAR) 2012-2017 and the One Health five-year action plan (2019-2024) are the strategic documents guiding in-house stewardship programmes. They recommend patient level prescribing data is feedback to prescribers, online dashboards, and innovative use of electronic resources to support stewardship aims.

The HAPPI data collection form is a tool used to collect patient level prescribing data and inform ward stewardship groups to direct antimicrobial quality improvement projects in their area.

Historically data from the paper forms had to be inputted manually by the AMS team to individual ward spreadsheets for dissemination back to the wards. This manual process was inefficient and time consuming and the time delay in receipt of results hampered ward level antimicrobial improvements Mal realised that digitalisation of this process would allow data to be uploaded directly onto the trust’s intranet by the auditor, providing a centralised database that could automatically produce graphical information with trust wide accessibility. Mal liaised with the Infection Control Senior Data Analyst (SDA) to investigate if the use of technology could improve the quality and efficiency of this process.

Working with the SDA, they identified the formic system used by infection control that would allow data to be inputted digitally into a central database. A specific formic form was developed to replicate the HAPPI Tool data collection. Mal piloted this form using PDSA methodology.
This online trust-wide spreadsheet has allowed automated results to be presented graphically by year, month, ward, division and directorate for each ward. Wards can upload and act on their own local data instantly, empowering staff to take ownership of antimicrobial stewardship practice Data can be viewed at board level to guide antibiotic stewardship strategies trust-wide.
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.
This innovation has had several positive outcomes

Increased engagement from ward clinical teams in the application of antimicrobial stewardship and ward level and integration of the principles of good stewardship in daily practice. This has been evidenced by an increase in the quantity of data collection, resulting in an increase in the number of local and ward level quality improvement projects within the field of management of antimicrobials.
Recognition and promotion of the work of the antimicrobial stewardship pharmacy team and trust board level. The work and success of this innovation has allowed the antimicrobial stewardship team to be one of the first services to avail of the new Qlik sense dashboard technology to allow us to further our influence and antimicrobial stewardship agenda
The work and the results from this innovation, and the potential to promote and encourage Trust-wide involvement and responsibility for the antimicrobial stewardship agenda has been recognised by colleagues regionally. This has led to another trust in the region seeking to adopt and implement this approach to data collection and dissemination.

How is the project to be developed in the future?
The Belfast Health and Social Care Trust have purchased QlikSense, a web based feedback system allowing information to be viewed via ward dashboards. The Stewardship team plan to avail of this system to further improve the availability of patient level prescribing data at ward level to inform areas for action and further quality improvement.

NHS Greater Glasgow and Clyde

Provide a brief overview of your project?
Antimicrobial stewardship (AS) initiatives are crucial in the fight against antimicrobial resistance. Using quality improvement (QI) methodology we can adapt our AS initiatives to meet the demands of the complex healthcare environment we work in. To determine if our AS initiatives are effective, we need to measure if improvement in AS has occurred. QI measurement and data analysis can be time consuming and challenging in a busy hospital environment. Change in antimicrobial consumption is often used as an acceptable easily accessible indicator measure of AS, however, using technology we can develop more reliable and specific measures of AS improvement.

A weekly antimicrobial ward round was recently introduced to the Royal Alexandra Hospital (RAH), conducted by an Infectious diseases (ID) physician and an antimicrobial pharmacist (AMP). This project set out to develop a database to enable efficient real time data collection of AS outcomes and interventions. The database was developed collaboratively with a data analyst. Outcomes were recorded using the following options: antibiotics stopped, IVOST, OPAT, escalated, de-escalated, no change. AS intervention options were also developed to measure AS input to patient care. In total seventeen AS interventions were agreed and defined including: therapeutic drug monitoring advice, antibiotic interaction advice, patient monitoring advice, microbiological sample advice. This format enabled AS to be measured and recorded even in patients where there was no change in antimicrobial therapy/consumption.

The database has now been used to efficiently collect data from nearly 200 ward round consultations. This has enabled ongoing measurement of AS outcomes and AS interventions from the ward round. This can be used as a more accurate AS measure as we develop this AS initiative to meet the demands of our service. Currently, nearly half (48%) of all ward round consultations have resulted in de-escalation of antimicrobial therapy (antibiotics stopped, de-escalated, IVOST).
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.
Efficient data collection and report generation has enabled timely local feed back of the AS improvement brought about by the antimicrobial ward round. This has helped support the case to make the weekly antimicrobial ward round a permanent service at the RAH. It is currently on a trial basis only. Antimicrobial usage data would not have been a sensitive enough indicator measure to show the AS improvement from the ward round. Patients are referred to the ward round from different wards all over the hospital so changes in antimicrobial usage data would not have been a suitable improvement measure.

Traditionally looking at outcome measure only would have shown that 39% of the ward round consultations didn’t result in any change in antimicrobial therapy. Although these consultations did not result in change in antimicrobial therapy, all resulted in AS interventions including most commonly; antimicrobial course length/stop date confirmation, patient counselling and education, drug interaction advice and drug route IVOST advice. Developing the database to record AS interventions has enabled more accurate measurement of AS input and AS improvement in these patients. This will help show the overall AS benefit of the ward round and support the case for making this a permanent service.

Efficient real time data collection has enabled the AMP to have more time to follow up on other AS initiatives including, education and training of staff, developing the role of our recently appointed antimicrobial pharmacy technician and promoting appropriate IVOST in surgical wards.

How is the project to be developed in the future?
In addition to the ID/AMP antimicrobial ward round, the database has been updated to enable AS interventions to be recorded for a range of other AS activities undertaken by the AMP. This includes new AMP/microbiology virtual ward rounds to follow up patients on broad spectrum (e.g. meropenem) and high risk (e.g. colistin, linezolid) antimicrobials from the NHSGGC ‘Protected’ antimicrobial policy. The database has also been developed to record AMP and antimicrobial pharmacy technician AS interventions. This can be used to show the benefit of these AS activities and build the case to support expansion of these roles and other AS activities.

The database has also been rolled out to another hospital in NHSGGC to record outcome and interventions from a new ID/AMP ward round. I would hope the database will eventually be rolled out to all NHSGGC hospitals to provide efficient measurement of AS interventions and QI initiatives.