Antimicrobial resistance


organisational planning and commissioning around AMR,61


including the use of educational


programmes for local school curriculums33,62 and recommendations to guide clinical practice. The guidelines are made available and understandable for patients’ reference, with accompanying patient decision aid documents. There is also a separate guidance for


organisations on implementing shared decision-making.13,14


While NHS organisations are


required to report compliance in consideration of recommendations in NICE guidelines, how much of the patient engagement element is truly being implemented in practice? Does the current healthcare set up challenge the practicality of time for patients to reflect and decide on treatment options? What if they wish to revisit the decision? The national Start Smart then Focustoolkit


for AMR, that provides clinical decision support tools for prescribers, is also referenced in the legal frameworks.60


However, the toolkit


makes no specific reference to patient engagement other than history taking.7


This


may be an assumption of patient engagement being undertaken as part of standard practice guided by NICE, or an assumption of patient engagement being less relevant in the conventional secondary care scenario with a


rather ill patient on a rather busy ward. However, studies indicate that even in this setting, patients respond positively to clear information about antimicrobials’ risk vs benefit, and are keen to receive information leaflets about antibiotic prescribing.63,64 All opportunities to shape infection management and antimicrobial prescribing decisions, guide health beliefs, and improve understanding are valuable at and beyond the point of care, including signposting to information for when the patients/relatives feel more able to receive them.65,66


To achieve this,


it is imperative that staff must receive relevant training and resources to facilitate patient engagement with AMR at the point of care.


Embracing patients as partners Over the past 75 years, the NHS, as a system, has evolved greatly in placing patients at the centre of care.67


However, the traditional paternalistic


and hierarchical culture and structure remain embedded68–70


and present challenges in getting


patients’ voices heard. Studies focusing on patient engagement with AMR and infection management highlight patient disempowerment when making healthcare judgements on their behalf. Themes include poor assumptions of


best interests, patient comprehension, accountability, liability, counter-productiveness, and fear of being observed for shortcomings in practice or creating a shift in clinician- patient and ward dynamics.71,72


Respect and


fear of medical authority gives rise to patient reluctance to question staff behaviours and decisions, even about their own health and infection management concerns, leading to misinformation, frustration and anxiety.66,73 The NHS Patient Safety Framework74


reference to looking not only at means of engaging patients with their own care, but also at strategic approaches for involving them as active partners in organisational committees. The 2019 NHS Patient Safety Strategy: Safer culture, safer systems, safer patients75


specifically alludes to AMR and


healthcare-associated infections as a patient safety issue and reiterates the need for patient safety partners to have the relevant training to contribute to service and clinical pathway design, governance, strategy and policies. Studies have found the dissonance between patients attributing the responsibility of AMR to clinicians76


most patients expect antibiotics.77


and clinicians perceiving that These


findings highlight that clinicians’ cue for patient participation in AMR discussion at the point


makes


December 2023 I www.clinicalservicesjournal.com 23


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