Antimicrobial resistance
l Bloodstream infections or sepsis l High risk co-morbidities (e.g. type-2 diabetes, cystic fibrosis)
A drive to increase self-reporting of ‘symptoms’ or risk factors for AMR could work in synergy with high priority national initiatives such as penicillin allergy de-labelling,93 and improve patient outcomes by encouraging self-care, prevention and risk reduction. Sharing real-life patient stories and impact on life is important to make the campaign relatable such that the serious threat of AMR is given the due attention. Subtly drawing insights to the antimicrobial prescribing competency standards54
in an
understandable manner will help setting realistic expectations among both clinicians and patients on when antimicrobial treatments should and shouldn’t be used, and what they can and can’t do. Working in synergy with existing bodies, such as ANTRUK24 and AMR Narrative25
, Antibiotic Guardian,12 UKHSA113 will avoid repetition, support
their organisations and strengthen the message to healthcare professionals and patients alike. Campaigns that can be shared globally will further enhance effectiveness.
8. Communicating and maintaining AMR relevant information across sectors Despite the availability of NHS Care Portal114 and Summary Care Records (SCR),115
there are
challenges in ensuring prescribers consider patients’ antimicrobial history when managing infections in primary and secondary care. In primary care, the allergy records often poorly differentiate between side effects and
The authors
Balwinder Bolla Consultant Antimicrobials and Infection Management Pharmacist and Antimicrobial Stewardship Lead for Lincolnshire.
Sue Wen Leo Antimicrobial and High Cost Drugs Pharmacist, ULHT.
Karen Fan Antimicrobial Admin Support, ULHT.
Gemma Lowles Antimicrobial Admin Support, ULHT.
Stacey Sharp Antimicrobial Pharmacy Technician, ULHT.
Conclusion In efforts to drive patient engagement with AMR, neither assigning prime responsibility to patients, nor continuing the paternalistic model of care, is sufficient. The ambition requires collective effort across health systems. There are strong government frameworks and existing supportive resources that should be optimised to ensure equity in accessing AMR information and receiving care to manage AMR risks.
While local AMR programmes have been
valuable in tackling local priorities, nationally led actions will set the scene across the UK, ensure more equitable distribution of
Leslie Jones Data Analyst for the Antimicrobial Team, ULHT.
Freeman Wu Antimicrobial and OPAT Pharmacist, ULHT.
Amy Holmes Infection Prevention and Control Specialist Nurse, ULHT.
Alicia Dixon Infection Prevention and Control Specialist Nurse, ULHT.
Sally Howitt Infection Prevention and Control Specialist Nurse, ULHT.
Elaine Freeman Patient Representative and formal Patient
26
www.clinicalservicesjournal.com I December 2023
Swapna R Motukupally Consultant Clinical Microbiologist, ULHT.
Sandra Smirthwaite Infection Prevention and Control Clinical Lead Nurse, ULHT.
Natalie Vaughan Deputy Director for Infection Prevention and Control, ULHT.
Andrew Simpson Urology Consultant Surgeon and Deputy Medical Director, ULHT.
Sally Blow Venous Access Nurse and lead OPAT Nurse, ULHT.
true allergy, or miss out crucial information, such as the nature of allergic reactions, altogether. The course length and indication of antibiotics are often unclear. Prescriptions from private providers and emergency services are not captured too. In secondary care, obtaining patient consent to access their SCR in acute scenarios can be challenging and this will impair prescriber decision-making. Despite NICE recommendations61
on good
documentation of infection and antimicrobial information, the quality of documentation in medical notes and discharge document remains a concern. Furthermore, there is no centralised section on care portal or SCR to capture all antimicrobial treatment history across sectors, thereby leaving a void for future reference. Implementing AMR passports will help, but a national delivery through NHS Digital will ensure standardisation across geographical areas and commissioning bodies.
Prescribers must discuss with the patient and/or their family members or carers (as appropriate): l The likely nature of the condition l Why an antimicrobial may not be the best or only option
l Alternative options to prescribing an antimicrobial
l Their views on antimicrobials, their priorities or concerns for their current illness and whether they want an antimicrobial among options available
l The benefits and harms of immediate antimicrobial prescribing
l What they should do if their condition deteriorates or they experience problems as a result of treatment
l Whether they need any written information about their medicines and any possible outcomes.
NICE NG15 Recommendation 1.1.31 61
resources and care, and contribute to global AMR strategies. Some ambitions laid out in this article will require further planning, funding, and effort. Drawing on other successful national health campaigns will provide insights into progressing patient engagement with AMR in a proactive, inclusive and structured manner. CSJ
Acknowledgements - Antibiotic Research UK (ANTRUK) - AMR Narrative
References available on request. Safety Partner at ULHT.
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