Antimicrobial resistance


how to improve patient engagement with AMR effectively, from a secondary care perspective of a rural healthcare system in the UK.


Availability and accessibility of patient information When patients are advised of the risk of AMR in relation to their health, the likelihood of them searching online for information may be influenced by emphasis placed by the healthcare professional, and whether they were given any written information or signposting. If they proceed to search online for ‘antibiotic resistance’, they will find websites of several large organisations that can provide relevant information and government initiatives that highlight the rising concerns of AMR.17–23 However, key patient-facing support and


research charities, such as Antibiotic Research UK (ANTRUK)24


or the AMR Narrative,25 do not


make it to the first page of the search results using two major search engines (Google and Microsoft Bing), with reduced likelihood of being noticed as a result of algorithm. Patient-facing information on antibiotics, AMR or infections, and signposting to support mechanisms, are not easily found, unless specific terms of antimicrobial (e.g. ciprofloxacin) or microorganisms (e.g. Methicillin-resistant staphylococcus aureus [MRSA]) are used in searches.26–31


It remains


elusive on whether patients are made aware of these resources to seek the support and guidance that they need. Are healthcare staff aware of these resources and actively considering them for patients? Digitalisation means printed leaflets and face-to-face consultations are becoming less common. How and when do these conversations take place? In comparison, internet searches on


well-recognised medical conditions, such as cancer, Crohn’s disease and asthma, generate an abundance of accessible and supportive information for the public on symptoms, diagnosis and treatments, with further signposting to patient counselling, financial support advice, and support groups.32–39


patient-facing information even elaborates on the research or trials underway for various treatments.40,41 Charity organisations, such as MacMillan Cancer Support,42


have set up drop-in centres


on hospital sites for patients and relatives to obtain information and emotional support in difficult times. Compelling and emotive TV advertisements, as well as government backed campaigns, further raise awareness for patients to self-check, understand risks, report symptoms, and seek help. Examples include smoking cessation,43


sepsis,44 and stroke.45


These findings highlight the need to make patient information on AMR and infection management more accessible and relatable to both the public and healthcare professionals. The public facing ‘Keep Antibiotics working’ campaign was effective in highlighting the threats of AMR.46,47


Nevertheless, using national


cancer campaigns as an example, the element of encouraging self-care and assessment using valid and easy-to-apply criteria, supported with safety netting and routes for escalation, can be applied to AMR health campaigns to improve patient participation and progress the role of patients in responding to AMR.15,48–51


Staff responsibility Each healthcare profession has a crucial role to play in patient engagement with AMR, via diagnosis, nursing care and medicines management, with patient counselling being a key feature.52


and Stewardship Competency framework53,54 for Nurses57 expects knowledge, skills, and


experience to be shared for the benefit of patients receiving care, but not specifically ‘with’ the patients themselves. This could be strengthened as nurse-led patient engagement is crucial in increasing patient awareness, shared decision-making, quality of life and interaction, with cancer care being a key example again.58


Organisational accountability The vision for an NHS that puts patients and the public first, where “no decision about me, without me” becomes a reality, has led to the UK Government White Papers and legal frameworks laying out organisational requirements to ensure adequate engagement with patients in this context.8,59 The Health and Social Care Act 2008: code


of practice on the prevention and control of infections, and related guidance,60


The Antimicrobial Prescribing is Certain


a welcome strengthening of the need for AMR- specific patient dialogue by all professionals that have a prescribing responsibility. Multidisciplinary dialogue with the patient on AMR awareness and implications is also supported by professional standards and code of conduct. The General Medical Council (GMC) ethical guidance on ‘Decision-making and Consent’ anticipates meaningful conversations with patients to facilitate their engagement, amidst the pressured environments and challenges in the NHS.55 The General Pharmaceutical Council (GPhC)


Pharmacy Professional Standards refer to multidisciplinary teams working in tandem with patients to deliver positive health, safety, and wellbeing outcomes.56


The Code of Conduct 22 www.clinicalservicesjournal.com I December 2023 draws


organisational assurances for infection management into 10 criteria required as an evidence base to maintain patient safety, identify risks and responses, and address corrective actions. Criterion 4 concentrates on improving compliance with information on infections, through communicating service users’ needs and utilising a range of global, national and local information resources to promote better understanding on infection management. Each organisation is required to interpret and translate the criteria at a local level in a Board Assurance Framework. This sets out the standards to achieve and opportunity to showcase specific patient involvement work. Building on this, with support of legal


frameworks, the UK National Institute for health and Care Excellence (NICE) sets out a variety of guidelines and resources to inform


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