From 18 – 24 November, teams around LUHFT will be highlighting the importance of antimicrobial resistance (AMR), which happens when bacteria, viruses, fungi and parasites no longer respond to antimicrobial medicines.
As a result of drug resistance, antibiotics and other antimicrobial agents become ineffective and infections become difficult or impossible to treat, increasing the risk of disease spread, severe illness and death.
The World AMR Awareness Week (WAAW) is a global campaign to raise awareness and understanding of AMR and promote best practices and the team will be hosting stands across the Royal and Aintree, as well as visiting wards, focussing on a different key topic each day.
Show your support by pledging to be an antibiotic guardian - Choose one simple pledge about how you’ll make better use of antibiotics and help save these vital medicines from becoming obsolete. Visit the teams hosting the stands and they can capture your pledge.
Themes throughout the week include:
Monday 20 November – Theme Antimicrobials in practice - ‘IV to oral switch’
- Using antimicrobials appropriately helps to improve patient outcomes, reducing antimicrobial resistance and decreasing the spread of infections caused by multi-drug resistant organisms.
- Misuse and overuse of antimicrobials is one of the world’s most pressing public health problems. The UK Government’s 5 year action plan has been designed to ensure progress towards a 20-year vision on AMR in which resistance is effectively contained and controlled by reviewing antibiotic course length, promoting shorter course lengths, empiric prescribing, switching from IV to oral forms and promotion of clinical guidelines.
- We have a dedicated antimicrobial stewardship team within pharmacy who work alongside other infection specialists at the Trust to help promote good antimicrobial stewardship practice.
- Pharmacists are well placed to review patient’s on intravenous antibiotics and promote IV to oral switch reducing the number of patients on broad-spectrum intravenous antimicrobials for extended durations.
We believe everyone has a role to play in making sure we optimise the use of antibiotics.
- Empirical antibiotics should be reviewed at 48-72 hours
- Spectrum of antibiotics should be reviewed once source of infection known
- Prolonged courses of IV antibiotics without infection specialist input should be highlighted by ward pharmacists to AMS pharmacist or prompted for discussion with an infection specialist
Check sensitivities – Right antimicrobial, right dose, right time, right duration, right route.
Prescriber's antibiotic checklist Start Smart Then Focus.
Tuesday 21 November - Theme Allergy status
Is it really a penicillin allergy?
- 9 in 10 people recorded as having a penicillin allergy are not actually allergic.
- Anaphylaxis occurs in around 1 in 10,000 people taking penicillin.
- Being unable to take penicillins puts your patients at a disadvantage, especially in admissions with severe infection.
A direct oral challenge of penicillin without prior skin testing can be performed in selected patients to rule out penicillin allergy. For more information, please discuss with your ward pharmacist who can review and signpost as necessary.
Key points:
- It is important for all staff to take an accurate allergy history and think about how untrue allergy labels can have a big, detrimental impact on how we can treat infections.
- Penicillin allergy is an abnormal reaction of your immune system. Signs and symptoms of penicillin allergy include hives, rash and itching within an hour of taking the drug. Severe reactions include anaphylaxis, a life-threatening condition that affects multiple body systems.
- Being labelled as having a penicillin allergy can limit the range of antibiotics that are available to them to treat the infection. Penicillin-based antibiotics are often the first choice of drug as they can treat a wide range of ‘bugs’ and cause few side effects. If a patient has a penicillin allergy label then alternative, second-choice antibiotics may need to be used instead. These antibiotics are often associated with higher rates of resistance or more side effects. This in turn can lead to longer hospital admissions, poorer health outcomes and higher mortality risk.
- Research has shown that penicillin allergies have been over-reported. The pharmacy team play a big role in trying to tackle these troublesome untrue penicillin allergy labels:
- On admission to hospital, take a thorough allergy history
- If a patient has an allergic reaction to penicillin whilst in hospital then pharmacists should ensure the details are recorded accurately to avoid use in the future.
- Ensure side effects such as vomiting or an upset tummy are recorded as an adverse effect rather than an allergy. This means that in the future the benefit vs risk of giving a penicillin can be weighed up.
- Prescribers to liaise with ward pharmacists to confirm allergy history and determine if a true allergy or not. Can then escalate patient to AMS pharmacists to review if suitable for a penicillin challenge.
Wednesday 22 November – Theme ‘Diagnostics’
- Focus on ‘Ditch the dip’
- Diagnostics are tests and investigations that determine what is causing a problem when a patient is unwell. They are important in treating infections as they help determine what bug is causing the infection and how best to treat it.
- Diagnostics play a crucial part in how pharmacists and clinicians review a patient.
- Pharmacists regularly review the renal and hepatic function of patients to guide whether a dose of a medicine needs adjusting or even if it means a change in medication. Many drugs, including antimicrobials need to have their dose amended if there is renal impairment and in the case of uncomplicated urinary infections, the first line treatment will not work if your renal function is not high enough.
- Lets make it better. Better infection diagnosis = better antimicrobial treatments = better patient outcomes.
- Blood cultures save lives! Right volume, send urgently to pathology and act on results ASAP.
- ‘Ditch the dip’ check guidance on whether your patient should be tested with a dipstick for suspected UTI.
Thursday 23 November - Research
Research staff are celebrating the amazing work happening to help in the fight against antibiotic resistance.
Some of our trials include:
The HAP-FAST trial – Helping personalise the treatment of hospital acquired pneumonia by identifying the pathogen causing the condition.
The PRONTO trial – A trial looking at the best use of antibiotics in patients with sepsis.
The SNAP trial – Determining the best type of antibiotic for septicaemia.
The Research team will be holding a stall at the Royal site on Thursday 23 November, talking to staff and patients about current research trials and how we are making a difference.
Friday 24 November - Prevention
- Antimicrobials are medicines used to treat infections caused by bacteria (antibiotics), fungus (antifungal), viruses (antivirals) and other microorganisms. Simply put they are ‘drugs’ that can treat ‘bugs’.
- WAAW are annual campaigns we use to highlight why it is so important to use antibiotics, as the most commonly prescribed antimicrobial, appropriately.
- Antimicrobials, especially antibiotics, are becoming less effective as microbes adapt over time to evade their effects. This can lead to more deaths and more complications for people receiving treatment. We must tackle this problem before it gets worse.
POSTER COMPETITION - WIN A £50 VOUCHER
As part of World AMR Awareness Week, the Antimicrobial Pharmacy Team are hosting a poster competition with the aim of reducing the risk of antimicrobial resistance (AMR) - and they want you to get involved!
Create a new ‘Start Smart Then Focus’ aide memoire for the Trust following the recent update of the national DOH toolkit.
Entries are due by Wednesday 22 November, and there's the chance to win a £50 Love to Shop voucher!
What is Start Smart Then Focus?
Start Smart Then Focus is an antimicrobial stewardship toolkit that helps to promote good antimicrobial prescribing practice, which in turn reduces the risk of antimicrobial resistance (AMR).
Start Smart includes assessing the patient for clear evidence of infection, prescribing in accordance with local guidance and documenting. Then Focus includes reviewing after 48-72 hours and making an antimicrobial prescribing decision.
It is important to reduce further antimicrobial resistance to ensure that current and new antibiotics do not become ineffective. Email entries to emma.