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Antimicrobial resistance


prevention programmes require patient engagement and motivation for optimal effect in shared decision-making, lifestyle choices, mental, physical, and social health, and risk management.65,103


Supported with education


and safety netting, patients’ outcomes would better reflect their preferences, needs, and values, rather than being determined solely by the healthcare professional. This will be work in progress, but the patient would be better informed and have shared responsibility in their health journey.104–106


4. AMR clinics The optimal set up of an integrated AMR clinic covering the key functions proposed earlier should be led by Antimicrobial Pharmacists, alongside Infection Prevention and Control Nurses. Where possible, access to Clinical Microbiologists and Infectious Diseases Doctors will further enhance multidisciplinary collaboration. Both GP and hospital referrals should be taken and clinics logged in the same way as other specialties, with Key Performance Indicators being monitored by the relevant AMR strategy group with patient representatives on board. Drawing from experience during the COVID pandemic, there is potential to utilise existing governance and data security for virtual clinics to establish a hybrid of virtual and face-to- face AMR clinics, with virtual clinics increasing the feasibility of a swift implementation and ability to include hard-to-reach patient cohorts, especially in rural areas. For face-to-face clinics, there must be some consideration given to logistics of physical space, feasibility for transport and parking, disabled access, infection prevention and control precautions including cleaning, personal protective equipment, audits, support staff requirements (e.g. housekeeping, reception and security teams), complement teams for anaphylaxis support when undertaking allergy de-labelling, counselling support for signposting, clear escalation routes, and appropriate tariff


Recommendations


1. Signposting to support groups and organisations 2. Mandate patient representation on Antimicrobial Resistance and Infection Control groups within Acute NHS Organisations and wider healthcare economy systems


3. Involving patients from the start – primary prevention and early identification 4. AMR clinics – interprofessional collaboration 5. Antimicrobial passports to be issued to patients locally, nationally and internationally 6. Professional bodies strengthening staff responsibilities and competencies 7. National AMR campaigns similar to cancer and stroke awareness campaigns 8. Communicating and maintaining AMR relevant information across sectors


payments to ensure sustainability. A well- structured and recognised AMR clinic would enable acknowledgement of, and an access point for, patient engagement with AMR.


5. Antimicrobial passports Likely to be in place in some areas within the UK already, but without national standardisation just yet, antimicrobial passports would be a worthy national and/or international concept to explore swiftly. Noting the rapid implementation of COVID passports107,108


carried by patients


and logged onto health database during the COVID pandemic, similar infrastructures are transferrable to implementing antimicrobial passports. The value of a local set up is outshone by national benefit if patients transfer across different localities. From an international perspective, being


able to capture patient’s antimicrobial allergy, resistance and treatment history would support the ‘One Health’ initiative - a collaborative, multisectoral, and transdisciplinary approach working at the local, regional, national, and


global levels.109–111


Some antimicrobial usage,


such as those obtained via unconventional means, would not be captured and perhaps present more challenges in countries with poor antimicrobial stewardship.


6. Professional bodies strengthening staff responsibilities and competencies In line with the UK Health Security Agency (UKHSA) Antimicrobial Prescribing Competency frameworks54


, the authors appeal to


professional bodies to specifically highlight AMR and patient engagement in professional codes of practice and potentially annual revalidation competencies. The nature of impact across the whole of healthcare and multiple disciplines makes universal application of competencies worthwhile in public interest. This would aid self- directed and organisational efforts to revisit educational programmes and ensure staff are informed and confident with AMR discussions.


7. New national public campaigns on AMR In addition to the first recommendation which suggests a local delivery of resources and signposting, a nationally led public and televised campaign, similar to cancer and stroke awareness campaigns,36,112


would be


beneficial to reach areas of deprivation with poor or reluctant access to healthcare. High- risk cohorts to target for self-awareness and reporting of risk factors include those with: l Recurrent infections and use of antimicrobials


l Antimicrobial allergies l Alert organism infections (e.g. MRSA, Vancomycin-resistant Enterococcus, Clostridium. difficile)


December 2023 I www.clinicalservicesjournal.com 25


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