Promoting the safe and effective use of antimicrobials
Antimicrobials include antibiotics, antivirals, antifungals and antiparasitics and there is a worldwide problem with treatment resistance to these medicines, which has been widely publicised and is getting worse.
According to the World Health Organization (WHO):
- Antibiotic resistance is one of the biggest threats to global health, food security and development today
- Antibiotic resistance can affect anyone, of any age, in any country
- Antibiotic resistance occurs naturally, but misuse of antibiotics in humans and animals is accelerating the process
- A growing number of infections – such as pneumonia, tuberculosis, gonorrhoea and salmonellosis – are becoming harder to treat as the antibiotics used to treat them become less effective
- Antibiotic resistance leads to longer hospital stays, higher medical costs and increased mortality
In order to combat the so-called ‘superbugs’, healthcare organisations are being encouraged to adopt a system-wide approach, known as antimicrobial stewardship, to promote and monitor the judicious use of antimicrobials in order to preserve their future effectiveness.
How can we combat antimicrobial resistance?
Preventing infections is a fundamental way of reducing the need for antimicrobials, and examples of this would include regularly washing hands, preparing food hygienically, avoiding close contact with sick people, practising safe sex, and keeping vaccinations up to date.
Commissioners are encouraging healthcare providers to implement antimicrobial stewardship by using contractual methods, including incentives for evidence of compliance. In addition, over-prescribing is also wasteful and, therefore, financially detrimental for the provider.
Whilst over-use and inappropriate antimicrobial treatment should be discouraged, there are risks in not treating patients, such as sepsis, which can be life-threatening.
NICE has provided guidance (updated in January 2018) on antibiotic stewardship, and one of the recommendations is that patients who are prescribed an antimicrobial medicine should have the following minimum information documented in their clinical record:
- Clinical indication
- Duration of treatment
In hospitals, it has become recommended practice for these details to be included by the prescriber on the patient’s prescription chart. This facilitates better management of the patient by having the information readily available at the time of drug administration and also for clinical review and audit.
Recording the treatment duration on the prescription chart is important to ensure the patient has an optimal course of antimicrobial medicine and recording this should also reduce the risk that nurses will continue to administer the dose unnecessarily.
The Ashtons visiting pharmacists will audit prescription charts to monitor whether these details are being recorded and will encourage prescribers to follow best practice where appropriate.