Minutes of the Scottish Antimicrobial Prescribing Group Meeting Held on Monday 23 rd June 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 Professor Marion Bennie, Chief Pharmaceutical Advisor, National Medicines Utilisation Unit, Information Services Division Ms Ysobel Gourlay, Lead Antimicrobial Pharmacist, NHS Greater Glasgow and Clyde Mr William Malcolm, Pharmaceutical Advisor, Health Protection Scotland Dr Susan Smith, Consultant Microbiologist, NHS Fife Dr Sara Jamdar, Consultant Microbiologist, NHS Forth Valley Mr Willie McGregor, Senior Charge Nurse, NHS Lothian Professor Ian Gould, Consultant Microbiologist, NHS Grampian and Scottish Microbiology and Virology Network Ms Jennifer Macdonald, Infection Control Manager, NHS Western Isles Mrs Helen Cadden, Public Partner Mrs Alison Macdonald, Lead Antimicrobial Pharmacist, NHS Highland Ms Jill Nowell, Lead Pharmacist, Medicines Utilisation and Pharmaceutical Public Health, NHS Forth Valley Dr Alexander Mackenzie, Consultant in Infectious Diseases, NHS Grampian Dr Gail Haddock, General Practitioner, NHS Highland Dr Gill Walker, Programme Director for HAI, NHS Education for Scotland Dr Simon Hurding, Medicines Management Adviser, NHS Lothian Professor Andrew Smith, Professor and Consultant Microbiologist, NHS Greater Glasgow and Clyde and University of Glasgow 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 Ms Susan Paton, Project Officer, Scottish Antimicrobial Prescribing Group Mr Andrew Wilkinson, Head of Healthcare Associated Infection and Regulation Team, Scottish Government Ms Gwen Bayne, Information Analyst, Scottish Antimicrobial Prescribing Group Ms Andrea Patton, Information Analyst, Scottish Antimicrobial Prescribing Group Apologies: Mrs Anne Lee, Chief Pharmacist, Scottish Medicines Consortium Dr Stuart Rodger, Associate Medical Director, NHS Greater Glasgow and Clyde Professor Alistair Leanord, Senior Medical Adviser HAI, Scottish Government Mrs Susan Roberts, Project Lead Scottish Antimicrobial Prescribing Group Dr Camilla Wiuff, AMR Lead, Health Protection Scotland Dr Teresa Inkster, Consultant Microbiologist and Infection Control Doctor Ms Vicky Elliott, Information Analyst, Information Services Division Dr Abhjit Bal, Consultant Microbiologist, NHS Ayrshire and Arran Dr Martin Connor, Consultant Microbiologist, NHS Dumfries and Galloway 1
Dr Stephanie Dundas, Consultant in Infectious Diseases, NHS Lanarkshire Professor Craig Williams, Consultant Microbiologist, Infection Control Doctors Network Ms Deidre Harris, Nurse Consultant Infection Control, NHS Fife and Infection Prevention Society Ms Anne Thomson, Lead Clinical Pharmacist Prescribing, NHS Greater Glasgow and Clyde Dr David Wilks, Consultant Physician, NHS Lothian Ms Julie Wilson, AMR Manager, Health Protection Scotland Professor Kevin Rooney, Lead Clinician for Critical Care, NHS Greater Glasgow and Clyde Mrs Arlene Brailey, Assistant Director of Pharmacy, NHS Education for Scotland Dr Alexander Crighton, Consultant in Oral Medicine, NHS Greater Glasgow and Clyde Ms Catriona Innes, Antimicrobial Pharmacist, NHS Orkney Dr Adam Brown, Consultant Microbiologist and Infection Control Doctor, NHS Highland Dr Ian McKay, GP Senior Partner and Clinical Director of Edinburgh Community Health Partnership Christine Gilmour, Chief Pharmacist, NHS Lanarkshire Dr Charis Marwick, Clinical Senior Lecturer, University of Dundee Guests: Jeannie Francis and Elizabeth Moore, American Pharmacy Students. Olga Moncyo, Microbiologist, NHS Lanarkshire Fiona Robb, Antimicrobial Pharmacist, NHS Greater Glasgow and Clyde Abdulrhman Mohana, PhD student, University of Strathclyde 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. Membership changes: Dr Michelle Watts representing Medical Directors, Primary Care has now stood down Dr Ian McKay, nominated by the Primary Care Leads Group, has now agreed to be member representing the Primary Care Leads. Dr McKay is currently a GP Senior Partner and Clinical Director of Edinburgh Community Health Partnership. Christine Gilmour, Chief Pharmacist, NHS Lanarkshire has agreed to represent the Chief Executives Group on SAPG and will link with Ian Ross, Chief Executive, NHS Lanarkshire on SAPG work. Professor Andrew Smith will deputise for Professor Alexander Crighton as dental representative. 2. Minutes of the previous meeting held on 28 th April 2014 2
The minutes of the meeting held on 28 th April 2014 were agreed subject to one minor amendment in the attendance list. 3. Matters Arising Trends in fosfomycin, temocillin and aztreonam use. WM advised that a report on consumption data would be available for the October meeting. It was noted that data for fosfomycin use may be problematic as the products being used are unlicensed in the UK therefore not captured via the Hospital Medicines Utilisation Database (HMUD). JS advised that the pharmaceutical company Nordic have launched Formicyt, an injectable formulation of fosfomycin and plan to make a submission to the Scottish Medicines Consortium (SMC). JS advised that the estimated timescale for the company to complete their submission and go through the SMC assessment process is at least 6 months and in the meantime boards should continue to use the unlicensed products. Items for Discussion and Agreement 4. Report on AMT Survey of maturity of antimicrobial stewardship. (Paper 1) CC presented the report which includes data from 13 NHS boards and highlighted the key results. CC advised that NHS Ayrshire and Arran data was received late but will be included in the second draft and that NHS Shetland have not had resource to complete the survey. It was agreed that the recurring funding for Antimicrobial Pharmacists should be reflected in the report. It was agreed that the key points for discussion from the AMT survey were patient safety focus and alignment, variance in boards in terms of resources, services and activities, mandatory professional development and assessment of training provided. It was identified that boards were not asked to comment on how they disseminate findings from prescribing indicators or audits to the clinical teams. It was agreed that boards should be approached to provide this detail and this will be added to the next draft of the report. It was agreed that within the executive summary detail should be added to clarify the context that delivery of the Scottish Reduction of Antimicrobial Prescribing (ScRAP) is in the very early stages. Action: Board to be asked to provide detail on how data is shared with clinical teams. Action: Second draft of AMT survey to next meeting of SAPG. CC CC/GB The Chair advised the findings from the AMT Survey report will inform the SAPG 3
strategy event which will take place on 11 th November 2014 and it was agreed that CC and GB would give a short presentation on the strengths and weaknesses of local stewardship The potential to benchmark hospitals antimicrobial usage data from HMUD was also discussed and it was agreed this should be discussed further at the AMT strategy event. 5. CDI HEAT target supporting indicators Papers 2 - Final Empirical Prescribing Indicator report in medical admissions April 2011 - March 2014 GB presented paper 2 which details progress with empirical prescribing in Acute Medical Admission Units (AMAU) during the past 3 years. Data shows that the measures of indication documented and compliance with local policy have improved and are now at or close to the target level in all boards. The Chair advised that SAPG made the decision to conclude formal reporting of the empirical prescribing indicator in AMAU in March 2014. Although formal reporting of the indicator will no longer be sought, the Chair encouraged all Boards to continue to monitor. A suggestion was that boards continue to do a snapshot report every 4 months to give reassurance that good practice is maintained. It was agreed that collection of AMAU data three times a year would allow this very important work to continue. The Chair advised there would be merit to local discussion as to best methods of data collection and this will be discussed further at the August SAPG meeting. Action: AMTs to discuss local data collection in AMAU to inform discussion at August SAPG AMT Leads Paper 3 Empirical Prescribing Indicator Report - Surgical Admissions April 2011 March 2014 GB advised that although only two boards achieved the target level for both measures overall compliance has steadily improved during the 3-year period. This indicator will continue to be measured in Surgical Admissions during 2014-15. Paper 4 Surgical Prophylaxis Indicator Report April 2011 March 2014 GB advised that data from ten boards have been included to provide national results with explanation from the missing boards included within the report. Several boards with long term compliance in colorectal surgery have now moved to collecting data in other surgical specialties. This indicator will continue during 2014-15 and will be measured in colorectal surgery or an alternative high risk specialty. The Chair advised that NHS Tayside are changing their data collection process after it came to light that data for surgical prophylaxis collected by the surgical team was not consistent with SAPG requirements. It was agreed by members that where staff from clinical teams collect prescribing data it would be beneficial for Antimicrobial Pharmacists to quality assure the data to provide internal validation. 4
6. SAPG AMT Event November 2014 The Chair advised that the November AMT event will focus on ScotMARAP 2 and the recent AMT Survey to discuss and the future strategic direction of antimicrobial stewardship in Scotland and priorities for SAPG in 2015-16. The Chair advised that the agenda was in development and called for any members with ideas for inclusion to contact SP. 7. Infection Intelligence Platform (IIP). (Paper 5) WM advised that the work of the IIP was showcased at the SAPG event in March and DN and CM have been visiting boards to highlight the work. A poster at the recent NHS Scotland event has also increased awareness within the service. A key development has been approval from the National Services Scotland (NSS) Privacy Advisory Committee which allows NSS to link data and will facilitate the exemplar studies in moving forward. 8. HAI Standards JS spoke on behalf of SR and advised that the 2004 HAI standards are currently being updated by Healthcare Improvement Scotland with engagement from all stakeholders including SAPG. The updated standards are progressing with further work ongoing on standardisation of language and format. JS advised that the revised standards will reflect current stewardship activities and the final draft will be circulated for wider consultation including SAPG members before implementation. Once published the standards will be used in Healthcare Environment Inspectorate inspections. 9. Future Point Prevalence Surveys The Chair advised that the date for the next national Point Prevalence Survey of Healthcare Associated Infection and Antimicrobial Prescribing will be 2016. Further details will be shared as they become available to facilitate board-level planning. 10. Evaluation of Antimicrobial Management Team (AMT) Event 10 th June 2014 JS advised the AMT event held on 10 th June 2014 which focused on education of healthcare staff and the public had evaluated well. The Chair asked members to submit any suggestions for future SAPG events to SP. 11. European Antibiotic Awareness Day (EAAD) 2014 Plans JS and CC attended the first meeting of the UK EAAD Planning Group hosted by Public Health England (PHE). As in previous years Scotland and the other devolved nations will undertake similar activities to those in England. This year communication of key messages via social media will be high on the agenda and SAPG will work with colleagues in Health Protection Scotland on this aspect. 5
There will be a registration scheme for organisations to submit details of their activities to support evaluation of EAAD by PHE. There will also be an on-line system for various healthcare professionals and the public to make pledges that support prudent use of antibiotics. This will be supported via the British Society for Antimicrobial Chemotherapy (BSAC) website and build on the success of the Antibiotic Action campaign. The role that community pharmacists can play in public education will also feature highly across Europe and in the UK. JS has made initial links with colleagues in the Scottish Branch of the Royal Pharmaceutical Society and Community Pharmacy Scotland (via Scottish Government) to support this. The non-prescription leaflet currently available via the Royal College of General Practitioners website is being revised for GPs and community pharmacists to use when patients present with symptoms of upper respiratory tract infection. The posters and leaflets distributed by SAPG last year which are based on those from the Department of Health will not be revised this year. However in addition to UK wide activities SAPG will develop a new poster highlighting key messages for hospital staff. It was agreed early communication of proposed activities to AMTs is essential to facilitate board-level planning. It was also agreed early communication with Healthcare Improvement Scotland and Public Partners is required. 12. Development of an education resource on antimicrobial stewardship for nursing staff The Scottish Executive Nursing Directors (SENDS) have approved the development of an education resource on antimicrobial stewardship for nursing staff. Senior nursing representatives from NHS Greater Glasgow and Clyde and NHS Tayside have volunteered to participate in this work. A project Steering Group will meet in July to develop a Project Initiation Document for submission to the HAI Task Force. An update will be provided at the next meeting of SAPG. Items for Information 13. Date of next meeting Date of next meeting is 25 th August 2014 at 12:30 in Delta House, Glasgow, with buffet lunch available from 12:00. The following meeting will take place on Monday 27 th October 2014. 6