Are you competent? What prescribers need to know. Janet Flint, National Programme Lead, Population Health and Prevention, Health Education England

Transcription

1 Are you competent? What prescribers need to know Janet Flint, National Programme Lead, Population Health and Prevention, Health Education England

2 Antimicrobial resistance the now The 7 key areas for future action: improving infection prevention and control practices optimising prescribing practices improving professional education, training and public engagement developing new drugs, treatments and diagnostics better access to and use of surveillance data better identification and prioritisation of antimicrobial resistance research needs strengthened international collaboration

3 Future AMR strategy Building on success, going further and faster with a focus on preventing infection, and reducing inappropriate use of antibiotics in both human and animal health. Reduce healthcare associated Gramnegative bloodstream infections in England by 50% by Reduce inappropriate antibiotic prescribing by 50%, with the aim of being a world leader in reducing antibiotic prescribing by 2020.

4 Code of practice on the prevention and control of infections There is appropriate ongoing education for existing staff (including support staff, volunteers, agency/ locum staff and staff employed by contractors), which should incorporate the principles and practice of prevention and control of infection. Providers should ensure that all prescribers receive induction and training in prudent antimicrobial use and are familiar with the antimicrobial resistance and stewardship competencies.

5 Joint PHE/HEE competencies implementation group Launched in 2015 and respondents included local education and training boards (LETBs), schools councils and medical schools. 86% of were aware of the AMPS competencies. Professions Antibiotics/ Antibiotic Curricula name antimicrobials resistance Doctors N Y Tomorrow's Doctors N N The Trainee Doctor Y N Foundation programme curriculum Y N Prescribing Safety assessment Dentists Y N Preparing for practice Pharmacists N N Future Pharmacists N N Performance standards for preregistration trainee pharmacists Y N Pharmacist independent prescribing programme Nurses N N Pre-registration nursing education Non-medical Standards for education providers prescribers Y Y and registrants Vets Y Y Code of professional conduct for veterinary surgeons

6 AMR prescribing competencies Five Dimensions: Infection prevention and control; antimicrobial resistance and antimicrobials; prescribing antimicrobials; antimicrobial stewardship; and monitoring and learning. Understands antimicrobial resistance and the roles of infection prevention, control and antimicrobial stewardship measures. Previous NPC framework Current prescribing framework

7 Embedding competencies into curricula Survey of HEIs sent through HEE local offices to health education institutions: medicine, adult nursing, dentistry, pharmacy, midwifery, AHPs and independent prescribing professions Asked about awareness of the national AMPS competencies and how the five dimensions mapped to learning content within #antimicrobialresistance #AMR

8 Health education institution survey COMPETENCY Dent Pharm Med Midw Nurs Ind Pres AHP 1: Infection Prevention and Control 100% 98% 99% 85% 86% 72% 94.2% 2: Antimicrobial resistance and antimicrobials 97% 100% 99% 59% 56% 75% 41% 3: Prescribing antimicrobials 88% 81% 96% 41% 29% 90% 30% 4: Antimicrobial Stewardship 73% 77% 91% 51% 42% 77% 25% 5: Monitoring and learning 50% 48% 63% 23% 16% 68% 14% Total average 82% 81% 90% 52% 46% 76% 40.8% 45 universities and 100 course responses [17 (65%) Medical, 13 (52%) Pharmacy, 22 (48%) Independent Prescribing, 5 (46%) Dental, 24 (42%) Nursing, 13 (25%) Midwifery and 7 Allied Health Professional courses]. 86 courses (86%) were aware of these AMPS competencies. The average implementation was 67% for all the dimensions

9 Health education institution survey Course Antimicrobial Resistance (average hours) Infection Prevention and Control (average hours) Dentistry 10 hours 9 hours Pharmacy 27.7 hours 9.95 hours Medicine 10.4 hours 11.2 hours Midwifery 6.8 hours 19.2 hours Nursing 4 hours 27 hours Independent Prescribing 7.45 hours 16.5 hours Allied Health 4 hours 16.5 hours We asked if undergraduates from different professions learning any parts of the antimicrobial resistance and IPC content together. 18 universities (40%) confirmed they provided inter-professional learning for undergraduates from different professions learning any parts of the antimicrobial resistance and IPC content together.

10 Prescriber training survey 61% confirmed that all prescribers within their organisation receive induction and training in prudent antimicrobial use. 40% confirmed prescribers are familiar with and/or given the PHE/ARHAI antimicrobial resistance and stewardship competencies. The most popular formats of resources were training workshops. More than 75% of the resources were targeted towards the training of medical prescribers (of all grades in both primary and secondary care including #antimicrobialresistance #AMR

11 Prescriber training survey Group Do you provide mandatory core training in prudent antibiotic use for doctors, pharmacists and nurses in addition to an introductory session on each induction? Is this repeated every three years and specifically covers those antibiotics that provoke CDI? All staff 6 (14% of CCGs and trusts) 3 (7% of CCGs and trusts) Clinical staff only 12 (28% of CCGs and trusts) 8 (19% of CCGs and trusts) All Prescribers (both medical and nonmedical) 26 (61% of CCGs and trusts) 8 (19% of CCGs and trusts) Medical prescribers only 17 (40% of CCGs and trusts) 7 (16% of CCGs and trusts) Pharmacists 13 (30% of CCGs and trusts) 2 (5% of CCGs and trusts) Nurses 6 (14% of CCGs and trusts) 2 (5% of CCGs and trusts) Allied Health Professionals 4 (9% of CCGs and trusts) 3 (7% of CCGs and trusts)

12 Introductory e-learning module

13 GP guide and animation v=pkyqjettzvo&feature=youtu.be #antimicrobialresistance #AMR

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15 NICE

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17 HEE Mandate HEE will: build on work started in 2014 to ensure that the APRHAI antimicrobial stewardship and prescribing competencies are embedded in professional curricula, including considering the results of the review undertaken in 2015/16 develop and implement an action plan for promoting examples of good practice by December 2016 continue cross-system work to develop and promote resources to support antimicrobial stewardship and good infection, prevention and control practices, giving particular priority to action which supports the ambition to reduce Gram negatives evaluate the visibility and uptake of HEE s introductory e-learning.

18 HEE AMR Deliverables 17/18 1. Explore the factors that promote or reduce AMR in different healthcare settings, through educational interventions in the working environment, via a series of focus groups involving practice educators. 2. Consider results of the review undertaken in to identify whether there are any gap areas in relation to educational resources available to support current prescribers with the responsible prescribing of antimicrobials. Develop and an implement action plan for promoting examples of good practice. 3. Work with PHE to develop an e-learning package around prescribing for UTIs for primary care clinicians to complement resources from TARGET, to be made available through elfh 4. Investigate options for the development of an individualised online formative assessment tool for health students and professionals on AMR and IPC to support targeted individualised learning and education for all levels of practice. 5. Improve information sharing around IPC training focussing on the educational resources that can be made available to support the reduction in G-ve HCAIs

19 Thank you for listening. Questions / Thoughts / Comments? Visit: prevention-public-health-wellbeing/antimicrobial-resistance Contact: janet.flint@hee.nhs.uk or mohamedsadak@hee.nhs.uk