The Scalpel's Blog

11.10.18

The right culture is key to antimicrobial stewardship

Prof. Dilip Nathwani is a speaker at the Infection Prevention Society’s Infection Prevention Conference 2018, consultant in infectious diseases and honorary professor of infection at the University of Dundee, and past president of the British Society of Antimicrobial Chemotherapy (BSAC). Here, he argues that the right culture is the key to antimicrobial stewardship.

Human studies suggest that more than one fifth of prescribed antibiotics are unnecessary or inappropriate. This is a major issue that threatens the effective prevention and treatment of an ever-increasing range of infections. A key factor in ensuring the correct prescribing of antibiotics is creating the right culture within whatever setting the antibiotics are used in. Antimicrobial stewardship aims to improve antibiotic prescribing and relies on a series of informed decisions made in a supportive, trusting and engaged environment.

Part of building a supportive culture means engaging fully with all the key stakeholders involved in the prevention, diagnosis and treatment of infection. For example, an integrated approach that sees the laboratory working closely with prescribing clinicians, stewardship and infection prevention teams will achieve better patient outcomes, increase patient safety and reduce antimicrobial resistance and C.difficile.

Trusting your multi-disciplinary team can also play a key role in antimicrobial stewardship. As the person present throughout the majority of patient activities, the role of the nurse in supporting stewardship activity is deemed important. For instance, if the patient is eating breakfast and is improving, they might be able to take oral antibiotics allowing the team to remove the intravenous line, a potential source of infection. To support this approach, we in Dundee have been at the forefront of supporting the development of the nurse’s role in stewardship. As a sign of the organisations commitment to this, we appointed the first antimicrobial stewardship nurse practitioner in 2015.

Providing education and the right environment and culture also means ensuring that healthcare workers feel confident in being able to tell patients that antibiotics is not the best course of action. Patients may put pressure on their doctor to prescribe an antibiotic when in fact they are unlikely to benefit from it. Whilst it might be tempting to prescribe a course of antibiotics to a demanding patient, or in time of great diagnostic uncertainty when working in extremely pressurised environments, we must be sure as healthcare professionals that the prescription is the right decision. Even if this leads to an antibiotic prescription, good stewardship is about getting that decision and prescription reviewed promptly so adjustments, including stopping the treatment, can be made. Once again an open, multi-professional, supportive team approach to prescribing that encourages review, reflection and feedback, and is a sign of a mature and high functioning system. Involving patients in this process is also key to success

The importance of ‘culture’ also applies more literally to the taking of microbiological cultures to identify the organism that is causing the infection. Of patients given antibiotics in US hospitals, around 40% have not had a microbiological culture. This leads to unnecessary use of antibiotics and often use of rather broad-spectrum agents, often for protracted periods, all of which drives antibiotic resistance. In addition to not taking cultures, the current available tests often do not grow the bug or take a long time to get the result to the prescribing doctors. This perpetuates the need to use antibiotics inappropriately. To optimise this, prescribers need to maximise the use of laboratories and, on the other hand, laboratories have to invest in emerging innovative diagnostics that will support the rapid identification of the organism and the best treatment. Reducing diagnostic uncertainty is fundamental to good stewardship. Finally, even if we achieve this, making sure that results from the laboratory are correctly actioned in clinical practice is critical to ensure optimal patient care and outcomes .

There is now strong evidence that a range of stewardship interventions, in a variety of settings, delivered by skilled teams working in a cohesive way that are supported by the organisation and its leadership, will have a positive impact of a range of clinical, resource, economic and microbiological outcomes. While we still need to understand many things about how best we tackle AMR, about why some things work in certain setting and not in others, the question is no longer if stewardship works, but rather how can we most effectively implement it. We all have a responsibility to ensure good antimicrobial stewardship.

 

Enjoying NHE? Subscribe here to receive our weekly news updates or click here to receive a copy of the magazine!

Comments

There are no comments. Why not be the first?

Add your comment

 

national health executive tv

more videos >

latest healthcare news

‘Damaging’ NHS targets ‘have had their day’ claims Lord Prior

15/02/2019‘Damaging’ NHS targets ‘have had their day’ claims Lord Prior

NHS targets “have had their day” according to Lord Prior as the head of the health service launches an attack on 25 years of flawed h... more >
Controversial shake-up of Kent stroke services given rubber stamp amid calls for judicial review

15/02/2019Controversial shake-up of Kent stroke services given rubber stamp amid calls for judicial review

A major reorganisation of stroke services across Kent and Medway have been approved following a unanimous decision by the Joint Committee of CCGs... more >
A&E waiting time performance hits all time low as NHS ‘buckles under the strain’

15/02/2019A&E waiting time performance hits all time low as NHS ‘buckles under the strain’

A&E waiting time performances in NHS trusts in England have hit their lowest level since regards began, according to the latest NHS statistic... more >

editor's comment

25/09/2017A hotbed of innovation

This edition of NHE comes hot on the heels of this year’s NHS Expo which, once again, proved to be a huge success at Manchester Central. A number of announcements were made during the event, with the health secretary naming the second wave of NHS digital pioneers, or ‘fast followers’, which follow the initial global digital e... read more >

last word

Hard to be optimistic

Hard to be optimistic

Rachel Power, chief executive of the Patients Association, warns that we must be realistic about the very real effects of continued underfunding across the health service. It’s now beyond doubt or dispute, other than in government, that the NHS is inadequately funded. Even the secretary of state has argued that it will need more mon... more > more last word articles >

the scalpel's daily blog

Blog: 5 minutes with Dr Tracy Vell MBE, Associate Lead for Primary and Community Care, Greater Manchester, Health and Social Care Partnership.

14/02/2019Blog: 5 minutes with Dr Tracy Vell MBE, Associate Lead for Primary and Community Care, Greater Manchester, Health and Social Care Partnership.

Ahead EvoNorth we caught up with Dr Tracy Vell MBE, Associate Lead for Primary and Community Care, Greater Manchester, Health and Social Care Partnership. Dr Tracy Vell MBE shares her thoughts on the Northern Powerhouse, what it means to her and why she thinks it’s important to attend EvoNorth.  What does your role as ... more >
read more blog posts from 'the scalpel' >
332 304x150 NHE Callout banner.

comment

Maximising volunteer potential in hospitals

14/02/2019Maximising volunteer potential in hospitals

Sam Ward, director of commissioned services at the Royal Voluntary Service, argues that the right training can help harness the power of voluntee... more >
Leading and managing experts

14/02/2019Leading and managing experts

A coaching conversation is likely to yield the best results. Managing experts in the health industry can be a challenging and varying responsibil... more >
Mesothelioma in the UK: a growing fight

14/02/2019Mesothelioma in the UK: a growing fight

The health impacts of asbestos in the UK can cast a much wider net than those in the construction and building sector. Liz Darlison, head of serv... more >
ICO: Cyber security and the NHS

14/02/2019ICO: Cyber security and the NHS

Peter Brown, acting head of technology policy at the Information Commissioner's Office (ICO), explains the importance of good practice in data pr... more >

health service focus

View all News

interviews

How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

24/10/2018How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

A dedicated national social care service could be a potential solution to surging demand burdening acute health providers over the winter months,... more >
RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

24/10/2018RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

The president of the Royal College of Physicians (RCP) has told NHE that the college’s new headquarters based in Liverpool will become a hu... more >
Duncan Selbie: A step on the journey to population health

24/01/2018Duncan Selbie: A step on the journey to population health

The NHS plays a part in the country’s wellness – but it’s far from being all that matters. Duncan Selbie, chief executive of Pu... more >
Cutting through the fake news

22/11/2017Cutting through the fake news

In an era of so-called ‘fake news’ growing alongside a renewed focus on reducing stigma around mental health, Paul Farmer, chief exec... more >