Ashtons’ new expanded audit on antimicrobial usage

Antimicrobial resistance has become a hot topic in recent years, with the emergence of strains of bacteria that are resistant to antibiotics. In the past, new antibiotics have been developed to overcome resistant strains but the World Health Organization now says that ‘clinical pipeline of new antimicrobials is dry’. In response to this, antimicrobial stewardship guidelines have been set up to ensure that antimicrobials are being used in the most effective way. One of our Lead Clinical Pharmacists, Tomasz Wojcik, previously covered the National Institute for Health and Care Excellence (NICE) guidance in this area in our Autumn 2019 issue.

The topic has also become a focus for NHS commissioning bodies, with topics around antibiotic use included in Commissioning for Quality and Innovation (CQUIN) in both 2019/20 and 2020/21.

In order to help hospitals demonstrate compliance in this area, Ashtons has expanded its audit to include more detailed information on antimicrobial (antibiotic, antifungal and antiviral) usage.

To be able to complete this, we are asking hospitals to have the following processes in place:

• Prescriptions for antimicrobials should have an indication specified. This allows our pharmacists to check for the suitability of the antimicrobial for the given indication.
• Prescriptions for antimicrobials should also have a course length specified, or be marked as ‘long-term’ if being used as prophylaxis. This allows for clinical checking of the suitability of the course length, and also means that staff administering the medication have a clear indication of when a course is due to finish.
• Where a patient is refusing doses of an antibiotic, the course is reviewed to see if it is still clinically appropriate. Intermittent taking of antibiotic courses can lead to the development of resistance, and so if a course is not being taken as prescribed it should be reviewed.

All the information from the antibiotic audit can be seen in the reporting section in Live View. This will make it a useful tool in demonstrating compliance with antimicrobial stewardship when asked by NHS commissioners.