Great Ormond Street Hospital for Children NHS Foundation Trust

Provide a brief overview of your project?
The Nosocomial project arose from a desire to represent the science embedded within the NHS which is often invisible to patients, families, and other NHS staff. By giving Healthcare Scientists a role in co-creating engaging and accessible drama, it also sought to upskill the scientific workforce to tell their story.

Nosocomial began in 2018 with series of workshops organised by Dr Elaine Cloutman-Green, Lead Healthcare Scientist at GOSH, and Nicola Baldwin, playwright, open to any Healthcare Scientists across London, whether based in academic or NHS institutions. These conversations – participants’ ‘hospital acquired’ experience – determined story, structure, scenes and development of characters. After initial workshops, Nicola wrote an outline; scientists and public were actively engaged in development, through to staging – even working with actors on the final performance.

Professional bodies and NHS / academic institutions supported our workshops and dissemination of the work. Over 35 scientists were immersed in the creative process, leading to a cultural shift in approaches to drama and its use as an educational tool both in those original scientists, and others who subsequently became engaged.

Nosocomial tells the story of JO, a Healthcare Scientist who falls ill. Her fevered science-fiction interpretation of what is happening is framed by science-factual story of colleagues devising her treatment. Character monologues provide insight and perspectives on AMR. After an initial run at Camden People’s Theatre in 2018, we began site-specific performances, continuing to involve the wider community by sharing our co-creative method and approach. We found it was not simply the product, but the joint creative process, which made this project so effective and impactful. Over 4000 people have so far been involved with Nosocomial with this number set to rise in an immersive version of the drama currently being developed, and our ‘Rise Of The Resistance’ AMR Drama Festival in 2021.
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.
Participation – 35 Healthcare Scientists took part in initial workshops to develop Nosocomial, plus another 30 who subsequently became involved. 10 creatives worked in the initial phase of the project; a wider group of 30 writers and artists have joined networking activities. 110 people have taken part in subsidiary education activities around Nosocomial, including patients’ families. For Pathology Week 2019, we ran ‘Hide & Seek’, a week of activities and discussion to encourage interdepartmental and interdisciplinary collaboration around public health issues, with particular emphasis on AMR.

Engagement – Over 1000 people have seen Nosocomial live at various performances. This has included pop-up performances at the Headquarters of NHS England, the 2019 CSO conference, and UCL Museums. We have reached out to over 3000 people in social media, and received invitations to perform in the Netherlands, and Iran. Also: interviews with participants in Microbiologist magazine; podcast for Scientific Training Network; participation in ‘Performing Health’ at UCL and collaboration network. ‘Remember, Remember!’ a children’s version of Nosocomial, was performed at Great Ormond Street Hospital; the story of Healthcare Scientists who time-travel back to pre-antibiotic London to solve the Gunpowder Plot. A digital version of this was available for patients and families to participate in the drama without leaving their wards.

Recognition – Nosocomial won the ‘Partnering Patients & Citizens CSO Award’ from Chief Scientific Officer of NHS England 2019. We received funding from Society for Applied Microbiology to develop education resources using drama and collaboration between Healthcare Scientists and artists. Funding from Royal College of Pathologists to support live performances. Funding from Healthcare Infection Society to support production costs of Nosocomial at Camden People’s Theatre. Workshop support from Royal Literary Fund. Funding from NHS England to stage promenade version of Nosocomial to raise awareness of AMR and role of Healthcare Scientists at NHS England sites.
How is the project to be developed in the future?
We are working with the Precision AMR initiative at GOSH and UCL to develop and deliver ‘Rise Of The Resistance’, a major, two-day, public science-theatre Festival Of AMR at Bloomsbury Theatre in May 2021. Using our workshop process and participant network to develop short plays, talks and live events, we will also stage Nosocomial as an immersive, interactive experience involving live drama and live science, aimed at schools, families, students and general public. We intend to tour this to Thackray Medical Museum in Leeds, in collaboration with Leeds City College, Leeds Playhouse Youth Theatre and Leeds Teaching Hospitals Trust. We continue to run workshops to encourage collaboration between Scientists and Artists to enable them to engage the public effectively around AMR.

University of Liverpool

Provide a brief overview of your project?
This innovative co-produced project, Raising Antibiotic AwarenesS thrOugh Drama in children and Young People (RApSODY), was funded by the University of Knowledge Exchange & Impact and Public Engagement Voucher Scheme. The aim was to improve antibiotic awareness in school-aged children and young adults through drama, in a co-production between the GenerationR Liverpool Young Persons Advisory Group (YPAG) https://generationr.org.uk/liverpool/, Attitude Performing Arts School (a community-based organisation aimed at 6-16 year olds), and Antibiotic Action, the public awareness arm of the British Society for Antimicrobial Chemotherapy (BSAC).

The project forms part of the dissemination activities of the he NIHR HTA-funded BATCH study (Biomarker-guided duration of antibiotic treatment in children hospitalised with confirmed or suspected bacterial infection), which aims to reduce antibiotic exposure in hospitalised children with infection www.batch-trial.co.uk.

The project combined science, medicine and the arts in partnership with healthcare professionals, charities and more importantly young people. The project aimed to explore young people’s perceptions of antibiotic use and tackle some of the major misconceptions that exist and threaten the future of antimicrobial resistance. The key aims of the project was to: co-produce and perform a play with young people to teach other young people about antibiotic resistance; co-create child-friendly education resources for children, young people, families, and teachers about antibiotic resistance; assess children and young people’s understanding of antibiotic resistance using the fora of drama

Two live performances took place with primary and secondary school children and young people, followed by additional activities that involved and engaged 400 children and young people. A Video of the live performance, education handout, before and after surveys to assess knowledge and understanding about antibiotic resistance were all shared via lesson plans to be used in schools or other youth organisations.
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.
This was the first opportunity for children and young people to really shape a research-based project tackling the issue of AMR using drama. This young-person led project illustrates that using drama as a means of increasing knowledge and sharing information about health issues with children and young people has many advantages, including: making the topic more relevant to children’s lives; it generated a conversation and made children consider their own self-management of healthcare for maybe the first time, and despite the serious nature of the issue the performance included take-home messages that was delivered in a fun and informative manner.

In total 400 primary and secondary school aged children from 40 different schools and youth organisations took part in the project.

Results from the baseline survey and after the play indicate that the play improved understanding and addressed the most common misconceptions about antibiotic resistance. For example, prior to the performance only 75 out of 203 (37%) children ticked false when asked if antibiotics can be used to treat colds and flu, compared to 177 out of 196 (90%) after the performance.
How is the project to be developed in the future?
We would like to use the script written by young people and develop an animation, narrated by young people. We could then share this with lesson plans and take home messages in schools and other youth forums across the UK.

Great Ormond Street Hospital for Children

Provide a brief overview of your project?
As part of World Antibiotic Awareness Week (WAAW) the Antimicrobial Stewardship team collaborated with our industry colleagues at Pfizer and working together to deliver a public engagement activity called Bug Bus. This was a large articulated lorry which contained interactive games, educational material and the chance for the public to engage with clinical teams about antimicrobial resistance and the work going on to tackle this. Photos enclosed. We had worked with Pfizer previously on a national schools ‘super bug’ competition and they were keen to build upon this engagement during WAAW. The ‘bug bus’ had been touring different places and it gave the opportunity for our AMS team to expand our public engagement and collaboration with industry.
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.

1. The educational aspect of the bug bus allowed us to have direct communication with the public and address and questions or concerns people had about antimicrobial resistance and the future. Interesting conversations about antibiotics, vaccinations, role of technology occurred with children and adults of all ages.
2. We encouraged hospital staff and Great Ormond Street Hospital school to attend to the bus in order learn more about antimicrobial resistance and also have some fun. This was also an opportunity to see and ask about the role of industry in tackling the problem.
3. This has build upon our already strong collaboration with wider partners (such as industry) to drive forward unique and exciting ways to educate the public.

How is the project to be developed in the future?
We plan to continue our collaboration with our industry partners and have already planned the next schools competition and will be working on new innovative ways for public engagement for the next WAAW in 2020.

University of Reading

Provide a brief overview of your project?
We continue to work in Rwanda to educate people about antibiotic resistance. Beat Bad Bugs, which was launched in 2019, became Beat Bad Microbes (BBM) following feedback from pharmacy users when the first set of materials was tested in Kigali and reviewed by pharmacists and people from Rwankuba village. Their comments and suggestions were taken into account a new set of materials funded by the University of Reading’s GCRF funding.

The new set of pilot materials was co-designed with pharmacists and members of the public who use community pharmacies:
– an antibiotic record card
– a series of posters to put in pharmacies, with key messages
– information cards for patients

The new materials were produced in English and in Kinyarwanda with input from pharmacists and pharmacy users and, in collaboration with the Rwandan Community Pharmacists Union (RCPU), were piloted in pharmacies in Kigali. This has led to improvements in day-to-day working practices for pharmacists keen to raise awareness of AMR, as well as recognition for the role they can play in raising public awareness of AMR. We also demonstrated that community pharmacies are ideal places to encourage people to change their behaviour in relation to the use of antibiotics. Feedback from RCPU was that their involvement in BBM has raised the status of community pharmacists and that it helped to: ‘empower our members and pharmacy professionals to provide our clients (patients) high quality service and keep antibiotics working.’

Interest in the project and the role that design can play in communicating information design about health continues. Manjula Halai was invited to present the BBM work at the Rwanda Community Pharmacists Association national conference in September 2019: ‘Beat Bad Microbes: designing to make a difference to communicating information about antibiotic resistance’.
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.
Engaging the public through co-design and action in community pharmacies
A village workshop (as part of the co-design process), in collaboration with RCPU, raised public awareness of antibiotic misuse: “Involving our village in this project was amazing as they learned a lot, now they are mindful that abusing antibiotics, taking antibiotics not prescribed by a recognized health professional and not completed the full course prescribed can harm their life, and they are the champions of this project” [Flandrie Habyarimana, Chief, Rwankuba village]. BBM materials that were trialled in pharmacies in Kigali raised public awareness of AMR. The materials included an antibiotic record card and information cards about how to take antibiotics correctly that fitted inside prescription bags. Pharmacists welcomed this time-efficient solution to conveying messages about using antibiotics: “All pharmacies should get these cards so that more patients can get them.”

Extending the reach of BBM
The work has reinforced the value of user-centred information design. Informed by their participation in the research in Rwanda, the Commonwealth Pharmacists Association (CPA) is now committed to co-design: “the importance of involving other healthcare professionals and community members, such as chiefs and community health workers. This was a key find as it will be important to involve them in future work too”. [CPA facilitator at Rwanda workshop].

New collaboration and partnerships
A workshop in Reading, with participants from Rwanda and the UK, reviewed the work in Rwanda and worked to identify new projects including next steps for BBM. As a result, a project ‘Tiny Test Tubes to Tackle Antimicrobial Resistance in Dairy Farming in India’ led by a pharmacy academic supported by Design Science has been funded by Innovate UK. A second collaboration between the Royal Berkshire hospital and the University of Reading resulted in a workshop to consider communication design and penicillin allergy.
How is the project to be developed in the future?
RCPU and the CPA are partnering to deliver the joint Commonwealth Pharmacy Convention in Kigali in Nov 2020. BBM will be showcased here and materials will be available to share with other pharmacists in the Region and beyond.

We are working with CPA to roll out the antibiotic card and related BBM materials in African countries beyond Rwanda to support the Antibiotic Guardian Africa campaign.

We will continue to work with the CPA who are keen to introduce design to their members: “The CPA have benefitted from learning how a design-led approach can benefit pharmacists with their learning and healthcare delivery. This can benefit how we further provide support for pharmacy in other CW [commonwealth] regions.” [CEO, Victoria Rutter]

NHS Leeds CCG

Provide a brief overview of your project?
Seriously Resistant is a local approach to a global healthcare crisis. Using creative tactics to deliver simple, consistent messaging, the campaign engages target audiences & is helping reduce antibiotic use.

Seriously was originally developed in 2016 as an insight-led campaign targeting students. Using prescribing data and insight from healthcare professionals, we have developed the campaign each year, tailoring it for key target audiences. During 2019, we targeted the highest users of antibiotics: young children via their parents / carers and schools and the over 65s.

Working with those target groups, we refined our campaign messages and tactics to effectively reach each audience segment. We adopted a deceptively simple strategy of directly engaging with each target audience in a creative and appropriate way, backed up by out of home advertising, social media and PR activity and online www.seriouslyresistant.com

Highlights included:

• A social media competition to name the giant superbug mascot (Doug the Bug)
• Taking Doug, Seriously bugs & ladders and information packs to family friendly events across the city during the summer holidays
• Developing a Seriously-branded lesson plan and superbug activity for 47 primary schools, as part of Leeds City Council’s healthy schools programme
• Creating a Seriously-themed newspaper, word searches and bingo for older people’s lunch clubs. Doug also attended an over-60s dance class
• Using Doug and a ‘pledge hedge’ to initiate conversations and collect action pledges during Antibiotic Awareness Week.
• Engaging NHS staff via a “guess who’s in the superbug costume” and “spot the superbug” competitions on our internal channels
• Creating Seriously resources for partner organisations, including content for internal channels and social media plans
• Out of home advertising on billboards, on buses and in bus stations.

Please cite 3 examples of outcomes or impacts from the project on tackling AMR.
Public engagement – the campaign engages with the public to educate them about how to keep antibiotics working and to encourage them to make a pledge to be an antibiotic guardian of the future. This allows us to have meaningful conversations to help people change their behaviour and protect antibiotics for themselves, their families and their community. Our plain English pledges have been approved by NHS England and tested with each audience group. By the end of our 2019 campaign, there were nearly 24,000 pledges to help keep antibiotics working. In addition, campaign recognition averaged 90-100% and recall of key messages averaged around 60%

Engagement with partners – the campaign’s success so far has secured the support of the city’s multiagency Antimicrobial Stewardship Group. This has enabled us to work with colleagues across the health and care system to deliver clear and consistent AMR messages, e.g. the city’s Healthy Schools team have used branded resources in lessons about handwashing. These have been backed up by materials for parents in take-home packs. When a family is then on social media or out in Leeds and spot a Seriously-branded bus or see Doug the Bug at a Breeze event, the AMR message js reinforced with each encounter. Similarly, the acute trust pharmacy team use Seriously-branded patient materials and community pharmacists have taken part in events and media interviews about the campaign. Engagement with GP practices has seen primary care prescribing rates steadily decrease.

Shared learning – the positive engagement we’ve had with the public and healthcare professionals, together with productive relationships with key organisations means that we’ve been invited to share our learning locally, regionally and nationally. As a result, the Seriously campaign has been adopted by NHS Wales, NHS Sunderland and South Tynside and NHS Calderdale CCGs
How is the project to be developed in the future?
We had learned from our previous campaigns that language barriers and cultural attitudes towards illness and medicine usage could be a challenge to engaging with AMR messages. With that in mind, our plan for 2020 was to focus on reaching non-English speaking communities via third sector organisations and community ambassadors. We had also planned to work more closely with health care professionals to ensure that they had the materials they needed to manage patient expectations and facilitate conversations. Unfortunately, COVID-19 has delayed those plans. In addition, we understand from anecdotal feedback that the pandemic has impacted prescribing of antibiotics. We are therefore talking to our pharmacy and public health colleagues to better understand the current situation and to re-think our campaign objectives and tactics.

Partnership work has always played a crucial role in the campaign. COVID-19 makes this even more important at a time when communications and engagement resources are likely to be stretched and health messages confusing. We will continue to share resources and learning with other organisations to help ensure the campaign’s legacy and continued development, as we work together to achieve our antimicrobial stewardship group’s ambition for Leeds to be known as the city that makes the greatest impact on antimicrobial resistance within the UK.

Antibiotic Research UK

Provide a brief overview of your project?
Recognising the gap in patient information and support, and its importance, the charity Antibiotic Research (UK) established the country’s first dedicated Patient Support (PS) Team in February 2019. The Charity realised the need for better patient advocacy and lack of the patient voice in decision making within AMR strategies. Further reports from organisations such as WHO, NHS and The Wellcome Trust (Reframing Resistance Report) all identified a gap for suitably worded public information, and support required by patients suffering drug resistant infections. Following a pilot year, the Charity Trustees have agreed continued support, prioritising provision of the PS service alongside supporting research.

Support is provided through multiple channels since needs and levels of health literacy, and IT skills vary. We provide a web-based portfolio of resources on resistant bacterial infections, a facility to confidentially email specific questions or request more information, and a dedicated telephone number for people to ring, text or request a call back from our PS Team. These were developed after engaging patients in semi-structured interviews about topics, detail and format.

The PS service is spearheaded by Arlene Brailey, a pharmacist and Jodie Christie, AMS Nurse Specialist. Patient enquiries are steadily growing monthly, primarily through the patient support email as are visits to the webpages, particularly on resistant UTIs. During the COVID-19 pandemic, the public have increasingly turned to our PS team for information as evidenced by ‘visits’ to the PS website pages where pageviews increased by 195% during April-June 2020 ‘Lockdown’ compared to Jan-Mar 2020. Other organisations recognise our unique expertise and refer patients in need of support and information related to drug-resistant infections to the PS Team. These include referrals through The UK Sepsis Trust, and online patient support communities such as ESBL and Chronic UTI Support Group, and Investigation of Chronic Bladder Infections.
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.
1. Support for patients
We are increasingly recognised as the go-to-place for expert information, advocacy and support. This is provided in accessible ways, based on research, responsive to patients’ needs and provided within 48 hrs. Our bespoke patient leaflets eg on Citrobacter koseri, Klebsiella pneumoniae are requested, and valued by patients who appreciate the unique service provided as evidenced by the following testimonials:

• Thank you for the info …I was prepared & got a lot of benefit from my [urology] appt.
• Thank you so much …I wasn’t expecting such a quick, personal response
• You truly do listen and take the time to help

2. Brokering the Patient Voice
We have brokered opportunities to speak publicly using patient voices to convey the devastating impact of recurring and resistant infection on individual lives. This proves cathartic for patients, enabling them to ‘play their part’ in fighting AMR, raising awareness, and inspiring action. Examples include:

• Lisa- blogs and Manchester Evening Times piece during COVID-19 shielding
• Ronda – blogs, and spoke at 2020 Longitude Prize International UTI symposium
• Nina – interviewed for The Wellcome Foundation AMR campaign, and speaker at the ANTRUK Annual Lecture (October 2020)
• Jill, a dentist- blogs and local media output on antibiotic dental stewardship

3. Influencing political and professional agenda
We have integrated the AMR patient experience into national agendas, using opportunities to inform policy makers, health providers, researchers, industry and patients/families.

• Westminster Health Forum 2020: to inform policy makers, researchers, pharmaceutical industry and clinicians developing the UK AMR strategy
• The Steward AMR series (MSD UK): a podcast
• Reform Think-Tank Report 2020 on AMR
• Guidelines Live conference 2019
• BioInfect Conference 2020, Manchester; reminding scientists and researchers that the patient is at the end of the development pipeline
• University of Manchester AMR awareness day
• Patient Participation Groups (primary care): virtual presentations

How is the project to be developed in the future?
The project is constantly evolving. We are building on reviews of the evidence and feedback from patients and the public to ensure our services meet their needs. We have developed a new resource Ask ANTRUK to respond to the public’s need for up-to-date information on the COVID-19 pandemic and what it means to them. We anticipate this will be retained longer term and be adaptable and responsive as the situation changes. We will continue our links with academic partners and students to access expert advice, increase our human resource and provide students with opportunities for social responsibility.

We shall build on our formal partnership with MGP Ltd who produce Guidelines in Practice for GPs and Pharmacists, use the intelligence gleaned through GP surveys about knowledge of antibiotic resistance, and engage the patient voice in this primary care arena to help bring insight and change.

We are focusing on further development of the online patient community which aims to be a supportive environment where patients ( and their families) of those with recurring or drug-resistant infections can openly discuss their experiences and concerns to obtain information and support from one another or from the Patient Support Team.

We are also looking to implement face to face group meetings where patients can support and learn from one another. This will include a seminar which brings patients and clinicians together (for example microbiologists, antimicrobial pharmacists/nurses and infectious disease specialists) for a learning event where question and answer sessions help enhance knowledge and encourage mutual understanding. Virtual delivery of these events will also be included in order to facilitate attendance generally and also to take account of the ongoing social distancing requirements. Patient stories and website information will be continually added and broadened to meet patient need and we will continue to influence and inform decision makers, clinicians and researchers by sharing the patient voice.

In summary we believe the public engage differently with the charitable sector – valuing, respecting and trusting charities to give impartial information. This has proved particularly true for the PS Team where issues are sensitive or patients don’t wish to engage, question or challenge healthcare professionals. We look forward to continued provision and growth of the Patient Support service.

Spanish Agency of Medicines and Medical Devices (AEMPS)

Provide a brief overview of your project?
The Antibiotic Resistance Symbol Contest is an awareness raising activity organised by the European Joint Action on Antimicrobial Resistance and Healthcare Associated Infections (EU-JAMRAI).

This project was born to find the first global antibiotic resistance symbol. We were looking for a tangible symbol, not a digital logo. Something tangible that anyone can make and worn by with pride; like the AIDS red ribbon.

Objective
This is a social awareness raising and behaviour change action. Our objective went beyond finding the best Antibiotic Resistance Symbol; we also wanted to use the contest as a vehicle to raise awareness about the big challenge of antibiotic resistance.

Audience
The contest was opened only to individuals. Anyone from anywhere and any age could submit their ideas.
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.

• Almost 600 applications from 45 countries around the world were submitted.
• The impact of the paid social media promotions raised to promote the contest: 695.099 people reached.
• 18 key organizations in the field of AMR were involved as members of the jury (the European Commission, the European Centre for Disease Prevention and Control (ECDC) or the European Food Safty Agency (EFSA), among others) and once the winner is chosen they will participate in the promotion and visibility of the winning symbol.

How is the project to be developed in the future?

• A tutorial will be prepared so that anyone in the world can make their own Antibiotic Resistance Symbol in their homes, schools, hospitals, day care etc.
• A communication kit will be prepared, published, promoted in social media (especially during EAAD and WAAW) and shared with any entity, organization or person who wishes to use and spread the symbol.
• Other dissemination efforts such as organizing social media challenges or promoting the use of the symbol among influencers and relevant people will be pursued to popularize the winning symbol.