World Antimicrobial Awareness Week – Great for Patient Care and Your Professional Development

National and worldwide healthcare awareness campaigns aim to improve patient care. Engagement with activities to support these initiatives can also aid practitioner development.

Introduction

Every week seems to have either a “National / European / World….. awareness day / week” and whilst we need to be vigilant about how the topics involved affect our patients every day, these events can provide a useful opportunity for us to reflect on our knowledge, skills and practice in these areas.  This week is World Antimicrobial Awareness Week and as we pass the mid-point of this event it is worth identifying activities we’ve engaged with so far (or where we may be able to do so in the coming days and weeks), e.g.

• Updating our knowledge in this area

• Discussing cases involving reviews of patients prescribed antimicrobials (or requiring a decision about whether to prescribe one) with a colleague

• Public health campaigns in community pharmacies, GP surgeries, hospital entrance areas

• Providing education sessions for groups of healthcare professionals

• Auditing of antimicrobial prescribing practices and adherence to guidelines

The aforementioned activities can also be used as evidence to support revalidation records and for Royal Pharmaceutical Society Credentialing Portfolios.    

Supporting Revalidation

All elements of the GPhC's revalidation requirements can be supported by engaging with World Antibiotic Awareness Week.

Continuing Professional Development Records

The opportunities for CPD records based on antimicrobial stewardship are vast, but you may find some of the reflective questions and sign-posted resources listed below useful for helping you identify your own development needs:

• Are you confident with the general principles of how to review an antimicrobial prescription?

  • Ahmad DA, Spencer JJ, Frost KJ, Bond SE.  How to evaluate the clinical appropriateness of an antimicrobial.  The Pharmaceutical Journal, PJ, August 2021, Vol 307, No 7952;307(7952)::DOI:10.1211/PJ.2021.1.95470.

  • Ashiru-Oredope D, Attwood H, Cullum R et al.  Switching patients from IV to oral antimicrobials.  The Pharmaceutical Journal, PJ, April 2023, Vol 310, No 7972;310(7972)::DOI:10.1211/PJ.2023.1.180821

• Are you up to date with the latest safety issues involving antimicrobials?  Some of the key MHRA alerts (from recent years) involving antimicrobials are listed below:

  • Medicines and Healthcare Products Regulatory Agency. Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects.  Published March 2019.

  • Medicines and Healthcare Products Regulatory Agency.  Systemic and inhaled fluoroquinolones: small risk of heart valve regurgitation; consider other therapeutic options first in patients at risk. Published December 2020.

  • Medicines and Healthcare Products Regulatory Agency.  Fluoroquinolone antibiotics: suicidal thoughts and behaviour.  Published September 2023.

  • Medicines and Healthcare Products Regulatory Agency.  Nitrofurantoin: reminder of the risks of pulmonary and hepatic adverse drug reactions.  Published April 2023

• Do you need to refresh your knowledge of the management of commonly encountered infections?

  • Aliberti S, Dela Cruz CS, Amati F, Sotgiu G, Restrepo MI. Community-acquired pneumonia. Lancet. 2021 Sep 4;398(10303):906-919. doi: 10.1016/S0140-6736(21)00630-9. PMID: 34481570.

  • Ullah N, Vishrolia C.  Skin and soft tissue infections: risk factors and presentations. The Pharmaceutical Journal, PJ, August 2023, Vol 311, No 7976;311(7976)::DOI:10.1211/PJ.2023.1.191226

  • Ullah N.  Cellulitis: Recognition and Management. The Pharmaceutical Journal, PJ, October 2023, Vol 311, No 7978;311(7978)::DOI:10.1211/PJ.2023.1.197337

  • Ng BY, Datoo M, Pill G, Dunsmure L, Othonaiou KD.  Urinary tract infection in adults: diagnosis, management and prevention. The Pharmaceutical Journal, PJ, September 2022, Vol 309, No 7965;309(3965)::DOI:10.1211/PJ.2022.1.155006

• Are you aware of the factors that may affect patients’ expectations of antibiotics?

  • Boiko, O, Gulliford, MC, Burgess, C. Revisiting patient expectations and experiences of antibiotics in an era of antimicrobial resistance: Qualitative study. Health Expect. 2020; 23: 1250–1258. https://doi.org/10.1111/hex.13102.

• Are you confident in being able to accurately identify antimicrobial allergies and discuss the risks associated with patients being incorrectly labelled with these allergies?

  • Cramp E, Hamilton R, Kerr F, Hamilton N.  Accurately diagnosing antibiotic allergies.  The Pharmaceutical Journal, 2018; 301, No 7915;301(7915)::DOI:10.1211/PJ.2018.20205068.

  • Wilcock M, Powell N.  Challenges of delabelling penicillin allergy.  Drug and Therapeutics Bulletin 2021;59:163-164.

  • The Royal Pharmaceutical Society have produced a penicillin allergy checklist for pharmacists to use in practice

  • Robinson J. Dangerous labels: Incorrect penicillin allergies fuel antibiotic resistance.  The Pharmaceutical Journal, 2020; 304, No 7938;304(7938):DOI:10.1211/PJ.2020.20207807

Reflective Account

For this year’s reflective account, pharmacists are required to reflect on (at least one of) the following standards:

• Standard one: Pharmacy professionals must provide person-centred care

• Standard two: Pharmacy professionals must work in partnership with others

• Standard five: Pharmacy professionals must use their professional judgement

If you need to challenge an antimicrobial prescription or make a prescribing decision about the use (or avoidance of) antimicrobials, you are providing patient-centred care and using professional judgement.  Contributions to campaigns that raise public awareness of the need to use antimicrobials wisely (including encouraging them to become an Antibiotic Guardian) or improve prescribing practices, will usually require working in partnership with others.  

Peer Discussion

The theme of your peer discussion this year could focus on:

• Changes you have made to your practice to demonstrate a more proactive approach to following the “Start Smart, then Focus” guidance

• Your awareness of current safety concerns involving antimicrobials and how these affect prescribing decisions

• The results of an audit of your prescribing of antimicrobials (which also supports the “Prescribing Governance” section of the Royal Pharmaceutical Society’s Competency Framework for all Prescribers)

Supporting Post-registration Credentialing

The activities listed at the start of this article can be mapped to various outcomes of the Post-registration Foundation, Core Advanced and Consultant curricula (depending on your level of input and the complexity of the task).  Portfolio evidence is stronger when it is corroborated by feedback; potential activities for individual supervised learning events are suggested below.

Mini Clinical Evaluation Exercise (Mini-CEX)

• Pharmacy First consultation in a community pharmacy

• Prospective review of a patient admitted to hospital with community-acquired pneumonia

• Counselling a patient on quinolone therapy, ensuring they're aware of the significant side effects to be alert for

Direct Observation of Practical Skills (DOPS)

• Ear, nose and throat examination; Urinalysis (see Topic Guide for the Post-registration Foundation Curriculum)

Case-based Discussion (CBD)

• Retrospective discussion of your involvement in the management of a patient with cellulitis due to poorly controlled diabetes

• Discussion of a patient that required you to advise on the monitoring of antibiotic levels and dose adjustment of aminoglycoside and / or glycopeptide therapy

Teaching Observation (TO)

• Delivering a teaching session to colleagues on accurately identifying antibiotic allergies

• Delivering a teaching session to colleagues on the management of community-acquired pneumoina

Quality Improvement Project Assessment Tool (QIPAT)

• Implementing actions following an audit of compliance with antimicrobial prescribing against local or national guidance

LEADER (Clinical Leadership Assessment Skills)

• Overseeing the update and implementation of revisions to your organisation’s antimicrobial formulary

• Organising a public awareness campaign in your pharmacy about antimicrobial resistance

Final Thoughts

Supporting the various national and worldwide awareness events not only helps to ensure better patient care but can also aid your development and demonstrate capabilities at different levels of practice.  I’ll be writing a similar article to this for another of these events in the future.