|
Jonathan Cooke is director of research and development
and clinical director of pharmacy and medicines management at South
Manchester University Hospitals NHS Trust, and is chair of the prescribing
sub-group of SACAR |
Much has been achieved since June 2003, when the Chief Medical and Pharmaceutical Officers announced that £12m would be allocated over a three-year period to promote prudent antibiotic prescribing through enhanced hospital clinical pharmacy activity. Many trusts have introduced, for example,
guidelines on prescribing by clinical indication and for surgical prophylaxis,
and are using appropriate audit results (eg, based on emerging problem
organisms) to focus guidance. There is also much evidence that, throughout
England, the antimicrobial pharmacist posts created with the Department
of Health funding have become well established.1
The prescribing sub-group of the Specialist Advisory Committee on Antimicrobial
Resistance (SACAR) has played a major role in the antimicrobial pharmacy
programme. It has drawn up and promulgated a template for trusts to use
as guidelines and has promoted methods for the calculation of antimicrobial
use. SACAR has also encouraged collaboration between antimicrobial pharmacy
staff, and others such as microbiologists, who work in the same geographical
region, so that data and techniques can be shared. Two national SACAR
conferences, which provided a platform for workgroups as well as presentations,
have been held. In addition, SACAR has supported members of other organisations,
such as the United Kingdom Clinical Pharmacy Association (UKCPA), whose
antimicrobial specialist interest group has, among other activities,
developed an electronic message board for subscribers, where daily questions
and answers from pharmacy practitioners are exchanged.
With the end of the “pump priming” funding, it is important
that this antimicrobial pharmacy activity is maintained and developed.
Chief pharmacists, for example, should have prepared and presented business
cases to secure continuing funding streams. These will need to focus
on activities such as ensuring an active presence on wards and clinical
areas, including attendance on consultant microbiologist ward rounds,
and developing and implementing trust antimicrobial policies. Carrying
out projects to review and optimise antimicrobial use across hospitals,
providing feedback of audit results and leading education programmes
on the rational use of antimicrobials to medical, pharmacy and nursing
staff will also be key.
For its part, some of the future work plans of the prescribing sub-group
of SACAR are:
· To develop a consistent national hospital database for the use of
antimicrobials in secondary care, working with other agencies, such as
the Health and Social Care Information Centre, the Healthcare Commission
(HC) and the European Surveillance of Antimicrobial Consumption (ESAC)
project group
· To promote the development and use of local and regional antimicrobial
use databases, for longitudinal and point prevalence analysis
· To develop consistent international hospital patient activity databases
to enable the use of common population denominators, working with agencies
such as ESAC
· To address differences in local resistance patterns and relate these
to antimicrobial use in both primary and secondary care, working with
the Health Protection Agency (HPA) and other SACAR sub-groups
· To develop evidence-based guidelines for the appropriate use of antimicrobials
in both hospital and primary care settings, working with other stakeholders
such as the British Society for Antimicrobial Chemotherapy (BSAC), the
HPA, the Royal Pharmaceutical Society and the UKCPA, and to encourage
local development
· To promote the local use of the above guidelines
· To develop audit tools for individual organisations to assess the uptake
and use of evidence-based guidelines, working with agencies such as the
HC
· To develop and promote appropriate strategies to educate and train
users of antimicrobials, working with other SACAR groups and external
agencies such as the DoH, the BSAC, the UKCPA,and universities
· To commission and organise meetings and conferences on the appropriate
use of antimicrobials
· To identify areas of research for the appropriate use of antimicrobials
and to prioritise and seek funding for specific projects
· To publish a report of the impact of this programme on the use of antimicrobials
in acute hospitals
· To seek areas of good practice and disseminate this information
· To continue to develop the SACAR website2 and to link with other useful
sites
· To work with the “Connecting for Health” team to ensure
that databases and information support tools are developed to ensure
the optimal use of antimicrobials
With these and other initiatives, it is hoped that the contributions
of pharmacists working in the antimicrobial field will continue to be
valued long into the future.
References
1. Wickens H. Antimicrobial use in hospitals: how are we doing? From
SACAR conference 2005, available as a PDF file
(550K)
2. SACAR website |
Hospital Pharmacist