Dental Antimicrobial Prescribing in the Midlands: A Regional Action Plan
The aim of the project was to create a resource to support an improvement in dental antibiotic prescribing. Further objectives included to present key prescribing data by different systems. This project comprised of two phases. The initial phase considered antimicrobial prescribing activity within the Midlands, through data collection (NHSBSA). The results demonstrated that prescribing in the Midlands, particularly East Midlands, was higher than the England average. Amoxicillin was the most prescribed antibiotic in our region. This conflicts with recent guidance, which currently recommends Phenoxymethylpenicillin, instead of amoxicillin.
The second phase involved a targeted regional action plan. I presented the prescribing activity data across the Midlands at local and national meetings. This permitted an open dialogue, between myself, practitioners and key stakeholders, which was enhanced through anonymous feedback and polls. It also enabled a targeted discussion, using tangible figures, to raise awareness.
I created a bespoke website dedicated to AMR in Dentistry. It is designed for patients, public, professionals and practices. It is a single resource combining latest evidence-based guidance and information to tackle inappropriate prescribing and AMR. It is freely accessible through mobile and desktop formats.
I have updated the national toolkit on Dental Antimicrobial Stewardship. I specifically adapted the national audit for regional use and in primary and secondary care settings. The audit tool has been made easier to navigate through drop-down functions and clearer design. This should enable streamlined use of audit and improve compliance.
I have developed additional communication tools. Firstly, I created a patient discussion tool to assist non-clinical staff when dealing with difficult antibiotic conversations, whilst safe-guarding patient care. Secondly, I have created a professional awareness campaign which displays the key aspects of stewardship and how to make an antibiotic pledge. It can be used through a variety formats (screensaver, poster, printout).
Regional website creation:
A bespoke single-resource website dedicated to tackling AMR and stewardship, which is free to access. It is designed for patients and professionals alike. It covers several domains including stewardship and audit, with the latest links to learning modules and guidance. Further domains are planned, including common infections and additional signposting.
Meaningful engagement is critical to demonstrate that our community is actively engaging with our regional plan and using the latest resources/toolkits to improve practice. Google Analytics are enabled on the website and will be used to continually monitor/track engagement. Ultimately, website engagement will demonstrate proof of concept and our regional development.
Updated Audit Tools:
I have updated the national audit tool, for use within the Midlands and within primary and secondary care settings. I used excel to simplify the audit spreadsheet, with the addition drop-down functions. This should reduce the time taken to input data. The clearer design and drop-down functions should be easier to navigate and ultimately enable improved compliance with our recommendations. We will enable practices to submit their audits for further incentives, including social media publicity and awards, which will further help to spotlight good practice.
Firstly, I created a patient discussion tool to assist non-clinical staff when dealing with difficult antibiotic conversations, whilst safe-guarding patient care. It is vital that our frontline team members are supported in having AMR discussions, with a simple 3-step strategy. Secondly, I have created a professional awareness campaign which displays the key aspects of stewardship and how to make an antibiotic pledge. It should help to signpost, whilst demonstrating engagement.
We plan to review outcomes of our three key initiatives over a period of 1 year. A range of measured outcomes are planned including measuring prescribing activity, audit submission, and website hits through Google Analytics.
The possibilities for our regional project are endless! Firstly, the website is growing with additional domains planned to further support antibiotic prescribing and tackle AMR. Ongoing updates are planned to ensure that links, communication, and interaction with our website are maintained. Google analytics will be used to monitor and track engagement within our region.. This can additionally be used demonstrate proof of concept. As a region, we believe that a single-resource, for professionals and public, on dental antimicrobial stewardship and resistance is a fantastic opportunity to reach a wide audience and emphasise a clear message.
Secondly, we recognise the importance of engaging our interprofessional colleagues to assist when patients present with dental infection/conditions. As such, we plan to incorporate an updated list of urgent care practitioners and out-of-hour practices to further signpost on our website. In addition, dental infection and signposting has been planned with pharmacy undergraduates to further develop interprofessional understanding and contribute to our shared goal. This will enable a cohesive, multi-professional and collaborative approach to AMR for the future.
Thirdly, we plan to drive regional engagement further by tackling regions with high prescribing activity. Additional meetings and data presentations are planned to further highlight differences in prescribing activity and support general practitioners to become more compliant. Practices will be encouraged to submit audit results for further incentives, such as AMR Champion of the Month and social media publicity.
The website and project will continue, through additional input from the incoming clinical fellow and Local Dental Chairs, to develop our website further and engage our region. Ultimately, the aim of our resources are to improve antibiotic prescribing. We hope that by centralising information into a single resource, which is free to access and houses several domains and tools, our regional practitioners will be successful in improving their prescribing activity and tackling AMR.
IV to Oral Antibiotic Switch – Supporting Timely IV to Oral Antibiotic Switch through development of accessible Clinical Decision Tools
Timely and appropriate IV to Oral Switch of Antibiotics carries many benefits to patient and public, and forms a significant aspect of tackling AMR. Direction is provided in policy and guidelines, but is not easy to recall at the point of prescribing or patient review. This is noted to lead to lack of prescriber confidence in making a decision to switch, and lends itself to a ‘just-in-case’ culture of prolonged IV antibiotic use. This project looked at two different means of bringing the learning process closer to everyday practice, in an easy to absorb way that could be directly applies to any patient case. The creation of a bitesize educational video, and a clinical decision tool on Microguide have both been very well received at ULHT, and have gained keen interest from other acute NHS Trusts, with whom we have gladly shared the files. The awareness campaign of the tool is still in progress at ULHT and is rapidly gaining more multidisciplinary support, with nursing staff and bed managers also keen to utilise the tools and prompt for timely decisions. The multidisciplinary and collaborative approach of the team developing these tools has been the key to success.
(1) Reduction in consumption of broad spectrum antimicrobials when moving away from IV antimicrobial agents, as most tend to have a wider coverage than needed for the particular infection, and switch to oral can be to more focussed agents.
(2) Reduced risk of IV line infections, and complications of prolonged hospital stay, including hospital acquired infections.
(3) Moving away from IV antimicrobials at an earlier stage will also lend towards shorter course of antimicrobials overall, as there is often misconception that prolonged requirements for IV antibiotics means very serious infection, which suggests longer oral step down is needed.
We will be launching a bigger awareness campaign at ULHT, coinciding with the new doctor’s intake, and as senior MDT colleagues as well as non-clinical colleagues are gathering pace with keen interest. We will be looking to capture more impact data, and also qualitative feedback to guide updates for future versions. We will also be exploring means of inserting evidence of tool application for our patient medical notes, which are paper-based at present, with plans to implement electronic records over the next few years.
Developing a Board and Online Game to Educate on Antimicrobial Resistance and Stewardship
Innovative effective training and capacity building are vital to the success of stewardship programmes, particularly when staff are new to the concept. The AMS game is a digital and physical board game intended to make stewardship training engaging and inclusive, generating fun and enthusiasm with a serious purpose and clear outcomes.
1. Improved knowledge of AMR/AMS globally through the use of this innovative resource which works in any setting and any platform. In addition to use in low to middle income coutries this game is an accesible resource for use in any health and social care setting in the NHS or elsewhere.
2. Build confidence and inter-disiplinary team working. Supports peer to peer learning and sharing of best practice to address AMR/AMS training needs.
3. Sustainability and global impact through the use of digital /online game and “”Buy one donate one”” rollout model.
AMS Game is used by CwPAMS and SPARC countries (Flemming funded) 22 countries. This will be promoted and expanded globally via CwPAMS 2. In addition given contraints on NHS training budgets the game will be promoted as a cost effective training resource throughout the UK. The game will be updated based on feedback and best practice.