We are current working on the following initiatives to optimise quality of prescribing and support reduction of antimicrobial resistance aligned with the ambitions of the Chief Medical Officer's Realistic Medicine approach.
Hospital Antibiotic Review Programme
This work involves developing an education resource and a quality improvement toolkit to support reliable reviews of IV antibiotics and documentation of duration for oral antibiotics. This is important to ensure that patients receive the right duration of antibiotic treatment and reduce the risk of antimicrobial resistance and other antibiotic-associated harms.
Penicillin allergy de-labelling
About 10% of the population are labelled as ‘penicillin allergic’, yet of this number around 90% of patients are not truly allergic and many could safely receive penicillin antibiotics. We are working with clinical teams to develop and test a risk algorithm to support assessment of penicillin allergy in patients whose history suggests that previous reaction to penicillin was not allergic in nature so that their allergy label can be removed. This is important as penicillin antibiotics are the best treatment for many types of infection, and alternatives may have more side effects and be less effective.
To date SAPG work has focused on improving antibiotic use in adults. However there are opportunities to improve practice both in hospital and the community to standardise and spread best practice. We are developing an education module and supporting quality improvement tools to optimise the use of antibiotics for prevention and treatment of urinary tract infection in children.
SAPG work has largely focused on prescribing by GPs and non-medical prescribers in the community, but a small proportion of antibiotic use is by dental practitioners. Several groups have been working with dental practice staff to optimise antibiotic use. Our multi-stakeholder group aims to bring all work in this area together and continue efforts to reduce unnecessary use of antibiotics in dental infections and support appropriate choice and duration of treatment.
Nurses and midwives play an important role in antimicrobial stewardship through administering and monitoring antibiotics and increasingly also as prescribers. SAPG has been working in collaboration with NHS Education for Scotland to develop education to support their role across hospital and community practice as well as to raise awareness about appropriate antibiotic use amongst social care staff.
Towards the end of life antibiotics
This new initiative brings together clinicians from across hospital and community settings to develop good practice recommendations on when and when not to use antibiotics in patients during their last days and weeks of life. This is important to ensure the best use of antibiotics in patients who are dying and prevent any harmful antibiotic-associated side effects and complications which may impact on quality of life in a person’s final days.