Antimicrobial Stewardship: Start Smart Then Focus
Antimicrobial Stewardship is defined as "an organisational or healthcare system wide approach to promoting and monitoring judicious use of antimicrobials to preserve their future effectiveness."
Antimicrobial Stewardship Programme
A Patient Safety Alert jointly issued by Health Education England, NHS England and Public Health England highlighted that antimicrobial resistance (AMR) has risen alarmingly over the last 40 years and inappropriate use of antimicrobials is a key driver. Between 2010 to 2013, a12% increase in hospital inpatient prescribing was reported. The consequences of AMR include increased treatment failure for common infections and decreased treatment options where antibiotics are vital such as during certain cancer treatments.
Antimicrobial Stewardship embodies an organisational and system-wide approach to promoting and monitoring the judicious use of antimicrobials by:
- optimising therapy for individual patients
- preventing overuse and misuse
- minimising the development of resistance at patient and community levels.
Resources
Start Smart Then Focus
Start Smart then Focus provides an outline of evidence-based antimicrobial stewardship practice
Ten golden rules for optimal antibiotic use in hospital settings
The Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide.
The statement outlined 10 axioms, or “golden rules,” for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice.
Think CARES
Within 48 to 72 hours, review and revise the clinical diagnosis and the continuing need for antimicrobials and document a clear plan of action for the antimicrobial review outcomes.
C: Cease antimicrobial prescription if there is no evidence of infection
A: Amend antimicrobials – ideally to a narrower spectrum agent – or broader if required
R: Refer to non-ward based antimicrobial therapy services for appropriate patients if available
E: Extend antimicrobial prescription and document next review date or stop date
S: Switch antimicrobials from intravenous to oral according to national IVOS (intravenous to oral switch) criteria
IV to Oral Switch
We need your help to review medications, with a particular focus on antibiotics and change from IV to oral where it is appropriate or even better stop antibiotic courses when they are no longer required!
At any point in time, 22% of hospital inpatients are being treated with IV antibiotics; with an average course length of 3.5 days. At Gloucestershire Hospitals, we know that approximately 25% of IV antibiotics can be switched to oral appropriately and safely.
Why are we asking you to make the switch?
We know that a timely switch can:
- Reduce hospital length of stay
- Avoid blood stream infections
- Improves patient experience’ mobility and comfort (national audit states 75% of patients prefer an oral route)
- Reduces adverse events
- Reduces consumption of broad spectrum antibiotics
- Reduces incidence of C. difficile healthcare-associated infections
- Reduces carbon footprint- oral antibiotics have a carbon footprint up to 70-fold lower than IV antibiotics
- Reduce medication costs
To support clinical staff with decisions to make the switch we want them to think ‘ACED’; this useful tool describes the criteria to make an IV to oral switch (IVOS).
The UK HSA have also created an IVOS decision aid tool that enables a prompt review from first dose of IV antimicrobial with a formal review completed within 48 hours and daily thereafter.