Minutes of the Scottish Antimicrobial Prescribing Group Meeting Held on Monday 25 th August 2014 Healthcare Improvement Scotland, Delta House, Glasgow

Transcription

1 Minutes of the Scottish Antimicrobial Prescribing Group Meeting Held on Monday 25 th August 2014 Healthcare Improvement Scotland, Delta House, Glasgow Present: Professor Dilip Nathwani (Chairman), NHS Tayside Mrs Alison Wilson, Director of Pharmacy, NHS Borders Dr Andrew Seaton, NHS Greater Glasgow and Clyde, Antimicrobial Management Team Mrs Arlene Brailey, Assistant Director of Pharmacy, NHS Education for Scotland Ms Ysobel Gourlay, Lead Antimicrobial Pharmacist, NHS Greater Glasgow and Clyde Professor Marion Bennie, Chief Pharmaceutical Advisor, National Medicines Utilisation Unit, Information Services Division Mr William Malcolm, Pharmaceutical Advisor, Health Protection Scotland Dr Susan Smith, Consultant Microbiologist, NHS Fife Dr Sara Jamdar, Consultant Microbiologist, NHS Forth Valley Dr Stephanie Dundas, Consultant in Infectious Diseases, NHS Lanarkshire Mr Willie McGregor, Senior Charge Nurse, NHS Lothian Ms Jennifer Macdonald, Infection Control Manager, NHS Western Isles Mrs Alison Macdonald, Lead Antimicrobial Pharmacist, NHS Highland Dr Alexander Mackenzie, Consultant in Infectious Diseases, NHS Grampian Dr Gail Haddock, General Practitioner, NHS Highland Dr Simon Hurding, Medicines Management Adviser, NHS Lothian Professor Andrew Smith, Professor and Consultant Microbiologist, NHS Greater Glasgow and Clyde and University of Glasgow Ms Anne Thomson, Lead Clinical Pharmacist Prescribing, NHS Greater Glasgow and Clyde Dr Stuart Rodger, Associate Medical Director, NHS Greater Glasgow and Clyde Dr Abhjit Bal, Consultant Microbiologist, NHS Ayrshire and Arran Dr Martin Connor, Consultant Microbiologist, NHS Dumfries and Galloway Dr Adam Brown, Consultant Microbiologist and Infection Control Doctor, NHS Highland Dr David Wilks, Consultant Physician, NHS Lothian Professor Craig Williams, Consultant Microbiologist, Infection Control Doctors Network Christine Gilmour, Chief Pharmacist, NHS Lanarkshire Dr Charis Marwick, Clinical Senior Lecturer, University of Dundee Ms Vicky Elliott, Information Analyst, Information Services Division Mr Sam Whiting, Infection Control Manager, NHS Borders In attendance: Dr Jacqueline Sneddon, Project Lead Scottish Antimicrobial Prescribing Group Ms Clare Colligan, Project Lead Scottish Antimicrobial Prescribing Group Mrs Susan Roberts, Project Lead Scottish Antimicrobial Prescribing Group Professor Alistair Leanord, Senior Medical Adviser HAI, Scottish Government Ms Susan Paton, Project Officer, Scottish Antimicrobial Prescribing Group Ms Gwen Bayne, Information Analyst, Scottish Antimicrobial Prescribing Group Apologies: Mrs Anne Lee, Chief Pharmacist, Scottish Medicines Consortium Professor Ian Gould, Consultant Microbiologist, NHS Grampian and Scottish Microbiology and Virology Network Mrs Helen Cadden, Public Partner 1

2 Ms Jill Nowell, Lead Pharmacist, Medicines Utilisation and Pharmaceutical Public Health, NHS Forth Valley Dr Gill Walker, Programme Director for HAI, NHS Education for Scotland Dr Camilla Wiuff, AMR Lead, Health Protection Scotland Ms Deidre Harris, Nurse Consultant Infection Control, NHS Fife and Infection Prevention Society Ms Julie Wilson, AMR Manager, Health Protection Scotland Professor Kevin Rooney, Lead Clinician for Critical Care, NHS Greater Glasgow and Clyde Dr Alexander Crighton, Consultant in Oral Medicine, NHS Greater Glasgow and Clyde Ms Catriona Innes, Antimicrobial Pharmacist, NHS Orkney Dr Ian McKay, GP Senior Partner and Clinical Director of Edinburgh Community Health Partnership Ms Andrea Patton, Information Analyst, Scottish Antimicrobial Prescribing Group Mr Andrew Wilkinson, Head of Healthcare Associated Infection and Regulation Team, Scottish Government Guests: Dr Irina Pristas, Microbiologist from Zagreb, Croatia. Dr Alan Pithie, Consultant Physician, Christchurch Hospital, Christchurch, New Zealand Ms Kelly Cairns, Antimicrobial Pharmacist, Melbourne, Australia. Ms Mila Hurtado-Perez, Antimicrobial Pharmacist, Golden Jubilee National Hospital. Ms Caroline Foulkes, Communications Manager, Scottish Medicines Consortium. Ms Elaine Ross, Infection Control Manager, NHS Dumfries and Galloway. Ms Jo McEwen, Antimicrobial Nurse, NHS Tayside Item 1. Welcome and Apologies Action The Chair welcomed all present and requested that any member declarations of interest should be advised in advance of relevant items. The Chair advised of apologies and guests as noted above. 2. Minutes of the previous meeting held on 23 rd June 2014 The minutes of the meeting held on 23 rd June 2014 were agreed. 3. Matters Arising Continued monitoring of compliance with policy in acute medical admissions units (AMAU). It was agreed that Antimicrobial Management Teams should check compliance with empirical prescribing in AMAU at least twice per year to ensure that indication for antibiotic use is being documented and that choice of antibiotic complies with the local policy. If non-compliance is identified a return to more frequent monitoring may be required. Items for Discussion and Agreement 4. Monitoring surgical Antibiotic use. (Presentation by Dr Alexander Mackenzie) 2

3 AM presented on the opportunities and challenges in NHS Grampian on monitoring surgical antibiotic use. The increasing piperacillin/tazobactam use was discussed and AM noted that face-to face discussion with surgeons had helped with improving use. The Chair advised that piperacillin-tazobactam use and the current restrictive 4C strategy will be discussed at the SAPG strategic event on 11 th November. 5. Dental Prescribing (Presentation) AS presented using the most current data available on dental prescribing. There has been a year on year increase in antibiotic prescribing in general dental practice and AS advised that it is currently unknown whether figures correlate with improved access to NHS dentists. Reduction in dental surgical interventions was discussed as a potential reason for increased prescribing of antimicrobials. Links to disease/referral/access patterns are currently unclear and a better understanding of pressures to prescribe is required. The question of penicillin V vs. amoxicillin was discussed and agreed a lack of evidence currently exists to move away from amoxicillin. AS advised that on dental prescribing the General Dental Council would take advice from SAPG and follow guidelines. The NES Scottish Reduction in Antimicrobial Prescribing education programme (ScRAP) was highlighted as a model which could be modified to educate dental practitioners /14 Primary care prescribing indicators report. (Paper 1) WM advised the primary care prescribing indicators report is the sixth report summarising key prescribing indicators for and that most of the report is good news. Total prescribing is down 7.1% which is the largest reduction since SAPG was established but may reflect the mild winter resulting in reduced levels of infection. Broad spectrum antibiotics continue to decrease in primary care. Dental prescribing has reduced but the reason for decrease is currently unknown. The report will be published on the ISD website in October and the format will allow each NHS board to compare data and results. 7. Progress with national primary care quality indicator. (Paper 2 tabled) WM advised that nine of 14 NHS boards met the level three quality indicator target for total antibacterial use that at least 50% of GP practices should be at or below the prescribing rate of the baseline national 25 th percentile or made the minimum acceptable reduction toward that level in 2013/14. Overall, 57.5% of practices in Scotland achieved this target. It is recommended that no change is made to the target for 2014/15 and that SAPG review progress in August 2015 when year two prescribing data will be available. The Chair advised that he supported retaining the current target and this was agreed by SAPG members. Implementation of the ScRAP programme which is supported by the Scottish Prescribing Advisers Association is expected to have a greater impact during 3

4 year two. JS suggested that a SAPG media release following publication of the report was being considered by SMC to publicise the positive impact of SAPG on antimicrobial resistance. 8. CDI Decision Aid. (Paper 3) The Chair sought comment and agreement on the CDI Decision Aid before wider consultation takes place. The Aid has been discussed and formatted by a specialist group with members from Health Protection Scotland, The Care Inspectorate, Scottish Care, Consultant Microbiologist and Care home pharmacist representative. It was agreed the decision aid should be more concise and the aid should be for care home staff only with a separate best practice bullet point list for GPs. It was highlighted advice for care home staff on dehydration monitoring required to be revised. It was agreed to revise as discussed and test the CDI Decision Aid in care homes with penultimate version to be circulated to SAPG members by for final comment. Action: Revise decision aid for care home staff and prepare separate GP guidance Action: Circulate final versions for sign off SR SP 9. Colistin consensus guidance. (Paper 4) The Association of Scottish Antimicrobial Pharmacists (ASAP) have developed consensus guidance based on current practice of Colistin dosage around Scotland. The content has been shared with the members of Scottish Critical Care Pharmacists group who have the most experience of using Colistin in practice. The paper has been brought to SAPG to present and seek SAPG endorsement as a national resource to facilitate safe and effective use of Colistin in patients with infections due to multi-resistant Gram negative bacteria. The Chair suggested it may be helpful seek comments from colleagues in Greece and India where Colistin is used extensively and agreed to do this on behalf of SAPG. Action: Seek comments on consensus guidance from contacts in Greece and India DN SAPG agreed the document is useful and suggested dissemination via ASAP, the Critical Care Pharmacists group and hosting on the SAPG website. Action: Disseminate and upload to SAPG website 10. Good practice recommendations for hospital antimicrobial stewardship. (Paper 5) AMacD/ SP AS updated that the revised document was originally produced in 2012 to give local Antimicrobial Management Teams a guide for their stewardship activities based on ScotMARAP. Most of these activities are now embedded in local boards but some variance in certain areas was noted in the results of the recent AMT survey. The refreshed document takes into account latest good practice and re-iterates the 4

5 requirements for each stewardship component. Subject to some minor amendments the document was approved. Links to other relevant SAPG guidance to be added and the addition of an anti-fungal section to be considered. The Chair suggested that final sign off should wait until after the strategic event. Action: Final version to be prepared following November strategic event for approval at December SAPG meeting AS/CC 11. Good Practice Recommendations for surgical prophylaxis. (Paper 6) The Good practice recommendations for surgical prophylaxis document was originally produced in 2012 to assist local AMTs implement the overarching SIGN guidance. This document has been updated to include recent best practice and incorporate recommendations from the revised SIGN 104 including timing now within 1 hour rather than 30 minutes knife to skin. It was suggested that Transplant surgery should be included. Dosing in overweight and obese patients was discussed and AMacD advised that ASAP will be starting a larger piece of work on this but may take some time to complete. The guidance was approved by SAPG. Action: Following minor amendment guidance to replace existing version on SAPG website CC/SP 12. Clostridium difficile infection (CDI) HEAT target prescribing indicators. Oral antibiotic prescribing in continuing care wards April June (Paper 7) GB presented the first three months of data for the new empirical prescribing indicator in Continuing Care Medical Wards. Following discussion of the results it was agreed that it would be useful to analyse the data using the initial denominator as well as the reducing denominator for all measures and include in next report. The Chair requested that AMT members highlight any difficulties with data collection to GB e.g. patient numbers, time commitment, collecting data only for oral prescriptions. It was confirmed that getting sufficient numbers of patients may be a problem in some Boards. Clarification was sought on whether duration should be recorded in medical notes or Kardex and it was confirmed data collection should reflect whether recorded on Kardex only effective from 1 st October. SAPG guidance on the indicator will be updated to reflect this change and circulated to AMTs. Action: Paper for October meeting of SAPG with data analysed in two ways. GB Items for Information 13. CDI HEAT target prescribing indicators Empirical prescribing in surgical admissions wards April June (Paper 8) GB advised that Surgical Admission report showed a slight reduction in median compliance and this will be monitored to make sure the trend is not downwards. 5

6 Surgical prophylaxis April June (Paper 9) Surgical prophylaxis indicator data for colorectal surgery in Lothian and Grampian has not been included in the report as has reached target so measurement has moved to another surgical speciality. 14. Revised draft of Antimicrobial Team Survey. (Paper 10) Following publication of the UK Antimicrobial Resistance Strategy Report (AMR) and refresh of the Scottish Management of Antimicrobial Resistance Action Plan (ScotMARAP). It was agreed that the Scottish Antimicrobial Prescribing Group (SAPG) should develop an on-line survey to take stock and reflect on the maturity of local programmes and how well embedded stewardship is across Scotland. A report on the survey has been produced which includes an Executive summary of key findings and the full survey results. JS advised that a matrix has also been produced which allows benchmarking of all boards across all areas of practice. It was agreed that it would be helpful to share this with AMTs and should be viewed as a supportive document to highlight areas for improvement. Formal consent will be required from AMTs to share their information with other boards. Action: Seek permission from AMTs to share data. CC/SP The Chair described the model used in Sweden in which feedback on performance is given to individual Boards and they are asked to identify 3 areas for improvement within three months. The Chair agreed this will be challenging but is a proven method which drives forward improvement. AS advised reports would be required to be circulated to Medical Directors and AMT Leads for action. This suggestion was supported by SAPG members. Action: Following consent for data sharing, circulate report and matrix to AMT Lead and Medical Directors and request identification of for 3 actions within 3 months. CC/SP November Strategic Day The Chair advised the areas for improvement in the report would be discussed at the strategic event in November The structure of the day will be short presentations and small group discussion of activities we should continue, new activities and activities we should stop. The day will inform the strategic direction of SAPG. 15. Infection Intelligence Platform (IIP) MB advised good progress is being made with presentations to e-health leads to inform of IIP work. Data extraction studies are timetabled to come out late autumn. The mechanics of the infrastructure governance is now almost complete and data linkage progressing apart from continuing issues with SCI store. Board level positive and negative blood cultures from ECOSSE is being progressed to provide an outcome measure for the Sepsis collaborative work A two page summary report will be available 6

7 for the October meeting of SAPG. Action: Update report for next meeting of SAPG. MB 16. Revision of Healthcare Associated Infection Standards (HAI standards) SR advised the draft of the HAI standards would be available for consultation on 27 th August The standards will be circulated to SAPG members for feedback within the consultation period. The closing date for consultation will be 24 th September and finalised document 24 th October. The standards include an increased level of antimicrobial input and the standards will be used to inform the Healthcare Environment Inspectorate inspection visits. 17. Sepsis Update The Chair advised that funding of the Sepsis programme is coming to an end in December 2014 and last learning event taking place in November. The Infection Intelligence Platform will be fundamental in continuing work on sepsis outcomes. This has been a significant investment and a formal report on progress and outcomes will be produced for the HAI Task Force. 18. European Antibiotic Awareness Day (EAAD) JS advised new posters have been drafted for GPs, dentists and hospitals and were circulated around the SAPG table. The key item this year is on-line antibiotic pledges led by Public Health England. A letter will be circulated from Scottish Government and DN to NHS boards highlighting the pledges initiative and seeking their support for local EAAD activities. As with previous years SP will be in touch with AMTs to request supply quantities of posters and leaflets. At European level there will be a Pharmacy focus this year driven by the European Centre for Disease Control. JS and CC have met with the Scottish Government Pharmacy Team and the Scottish branch of the Royal Pharmaceutical Society to ensure engagement of community pharmacists throughout Scotland. 19. Development of an education resource on antimicrobial stewardship for nursing staff. The development of an education resource on antimicrobial stewardship for nursing and midwifery staff has been supported by the HAI Task Force National Advisory Group (NAG) and a request for funding will be considered at the September meeting of their financial group. A scoping exercise is currently taking place via an on-line survey and ward walk abouts to identify learning needs of nurses and midwives of various grades and across all specialties. The survey will identify the target audience of the training resource and inform the content and delivery format. JS will update on funding and progress at next meeting of SAPG. Items of information 7

8 20. JS advised that ScotMARAP 2 is now available on the SAPG website. 21. AOCB SAPG now officially registered to comment on NICE consultations and will be on consultation notification list. Relevant items will be circulated to SAPG and feedback collated for feedback to NICE. BSAC AMR round table events - registration places are still available. RE: ESCMID Postgraduate Education Course: How to design and perform your clinical studies in Infectious Diseases and Clinical Microbiology, Tübingen, Germany, 7-8 November Places available on this in depth course on research methods and data analysis. The Chair advised that BSAC have developed a web based point prevalence (PPS) tool for antimicrobial prescribing and can provide feedback in real time. The merit and value of the tool had been discussed at the SAPG project board and agreed as very useful. It was agreed to seek further information and perhaps a presentation from BSAC for a future meeting of SAPG. Action: Approach BSAC to attend October meeting of SAPG. ECDC mandate for HAI and antimicrobial prescribing point prevalence survey every 5 years will continue as normal. DN 22. Date of next meeting Date of next meeting is 27 th October noon for 12:30 in Delta House, Glasgow. The following meeting will take place on Monday 8 th December