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Antimicrobial resistance


of care is a key enabler in improving patient ownership and understanding of their central role and responsibility in AMR at and beyond the point of care. Key areas to foster patient engagement


include improving understanding of their risk factors in contracting multi-resistant microorganisms and/or recurrent infections, and implications of AMR. Discussions should not be limited to informing of the risks of morbidity and mortality, but should also offer opportunities to discuss and mitigate psychological, financial and social impact. Recurrent infections, such as Clostridium difficile, have been found to have a devastating impact on patient’s mental health and professional lives, leaving them feeling hopeless of being cured from the infection and fearful of recurrence.78


different microorganisms,79 patient demographics78 rurality82


Disparity in media coverage of cultural factors,80,81


and poor accessibility in may further impede patient engagement


and positive healthcare-seeking behaviours, and cannot be overlooked in the effort to enable holistic and inclusive AMR conversations. Such conversations allow patients the opportunity to understand the pharmaceutical treatment they can and cannot have, including reasons for being on broad-spectrum antimicrobials, treatment effectiveness, compliance, adverse effects, drug and dietary interactions, monitoring requirements and any associated costs. Furthermore, there are vast opportunities in engaging patients with non- pharmaceutical interventions to promote self- care, prevent primary and secondary infections and enhance treatment outcomes. Examples include hand hygiene in all vascular access and line care,84


settings,83 wound and dressing care,85 and prevention of


catheter-associated urinary tract infections86 and surgical site infections.51


Using existing resources, such as the urinary catheter


passport, to complement these interventions will help to bridge the existing information gap and enhance communications between patients and clinicians.87–89 Conversations around antimicrobial treatment


allow opportunity to revisit patient’s allergy record, as incorrect labelling of penicillin allergy is found to be a growing problem contributing to AMR by exposing patients to restricted and/ or broad spectrum antibiotics that carry higher risks of adverse effects, involve more frequent administrations and select resistant strains.90 Even when a penicillin allergy label is found to be inaccurate, there are behavioural and practical challenges in de-labelling penicillin allergy,91,92 such as communicating and maintaining accurate health records across settings. The concept of an antimicrobial passport merits consideration in this context. These findings point towards the need


to provide patients’ equitable access to antimicrobial specialist advice and opportunity to revisit their understanding of AMR. One such mechanism includes antimicrobial specialist clinics on AMR and penicillin allergy de-labelling,93


supported by cross-sector


clinical pharmacists, consultant microbiologists and infection management teams,94


and


infrastructure to maintain and update accurate health records and communications.


Recommendations 1. Signposting to AMR information and support groups Accessibility to resources and prompts at the point of intervention should be considered together for best effect.95


as ANTRUK and the AMR Narrative24,25


Organisations such have


produced patient support materials that could be incorporated into treatment protocols and pathways in secondary care for resistant and/ or recurrent infections. ANTRUK also offer a


24 www.clinicalservicesjournal.com I December 2023


dedicated patient support service for those affected by antibiotic-resistant infections.


28


Other points of access to information for patients include having printed leaflets well placed in pharmacies for handing out with antimicrobial medications. Television screens in General Practitioner (GP) surgeries and QR codes on well-placed posters could facilitate signposting. Utilising existing digital resources, such as the NHS app,96


in embedding NICE


patient decision aids on infection management14 and the primary care AMR ‘TARGET’ toolkit97


also facilitate public insight and encourage self-care.


2. Mandating patient representation in organisational and system AMR groups Mandating patient representation and empowering them with an active role at AMR related strategic groups and committees in NHS organisations and integrated care system is a cornerstone of true multidisciplinary collaborations.67,74,75,98,99


Participation of patient


safety partners and direct incorporation of patient safety frameworks into AMR clinical strategies and pathways would enable valuable and structured patient perspective in informing practice, encouraging clinicians’ reflection, designing health education, providing assurance on inclusivity, openness and transparency, and guiding resource allocation.


3. Involving the patient from the start – primary prevention and early identification As seen with other chronic health conditions,100–102


the concept of primary and


secondary prevention needs to be actively applied to AMR, supported with risk assessment tools. Preventative measures include identifying and educating patients on modifiable risk factors of infections and encouraging positive healthcare-seeking behaviour. Infection


could


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