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Jonathan Cooke is director of research and development
and clinical director of medicines management and pharmacy at University
Hospital of South Manchester NHS Foundation Trust
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Responsibility for infection control in NHS bodies lies at the door
of trust chief executives, as described in the Health Act 2006 and the
code of practice for the prevention and control of healthcare-associated
infections.
Included in these statutory requirements is a duty to adhere
to policies and protocols applicable to infection prevention and control.
This duty contains a section on antimicrobial prescribing which requires
that: • A policy exists that is harmonised with the British National Formulary
and incorporates the measures outlined in appendix 2 of the HCAI code
of practice
• The policy includes information on the drug, regimen, route and duration
of treatment, including IV to oral switches
• Policy implementation and application is monitored via the organisation’s
clinical governance system
• There is a rolling programme of policy audit, revision and update
• There is someone undertaking the role and responsibility of antibiotic
pharmacist
• Antimicrobial prescribing data is analysed by the antibiotic pharmacist
and routinely fed back to clinical staff or directors of infection prevention
and control
These criteria will be rigorously assessed by the Department of Health
as well as external organisations such as the Healthcare Commission
and Monitor. While no chief executives or NHS organisations have yet
been
prosecuted under the Health Act, the instruments are in place for this
to happen.
Progress
Much progress has been made in the field of infection control and antimicrobial
use since the DoH provided funding for the hospital pharmacy initiative
in 2003. The Healthcare Commission reviewed the initiative as part of
the NHS annual health check for acute hospitals and found that most trusts
have used the funding to employ additional clinical pharmacy staff.
Over 100 specialist antimicrobial pharmacists were funded in English
trusts, at least partially as a result of the extra funding. In April
2005 there were 141 such specialist staff in post. Thus, 88 per cent
of trusts in England had at least one member of pharmacy staff specialising
in microbiology or infectious diseases following the initiative, compared
with 6 per cent in 2000.1 Antimicrobial pharmacists have produced benefits
for both the NHS and patients that are directly attributable to the extra
funding.
There have been a number of local networks of antimicrobial pharmacists
set up to share practice, conduct benchmarking activity around antimicrobial
use and organise collaborative research. The UK Clinical Pharmacy Association
infection management group continues to flourish and develop strong links
with other professional organisations. An interactive web-based forum
allows members to alert each other and share practice.
The antimicrobial stewardship team model (multidisciplinary antimicrobial
management) that includes a clinical pharmacist and microbiology or infectious
diseases staff, is well accepted and forms the basis of the DoH’s
latest recommendations on best prescribing of antimicrobials.2 These
benefits have been described in terms of clinical, microbiological and
financial outcomes, along with examples of innovative practice.3
A further commendation of good practice for addressing antimicrobial
prescribing was described in the latest Healthcare
Commission report on healthcare-associated infection (Hospital Pharmacist 2007;14: 245).
A number of hospitals have reported considerable reductions in their
expenditure on antimicrobials. In England, expenditure on antimicrobials
in acute hospitals fell for the first time in 2005, after annual 10 per
cent rises over at least the previous four years.
A framework for the use of antimicrobials has been published by the DoH
and should become the key instrument for hospitals to address their antimicrobial
use.4 The DoH has also published a self-assessment tool which can be
used by organisations to help them plan and implement strategies for
prevention and control of HCAIs.5
This month, the DoH has also announced £270m of extra funding to
support infection control. It has published
a strategy document detailing
new areas in which the NHS should invest. £45m of this
funding has been identified for investing in specialist staff, including
antimicrobial pharmacists. The document also states that applications
for foundation trust status would not be supported unless the trust can
prove that targets for infection control are consistently met.
There are now no excuses for poor use of antimicrobials in hospitals.
Chief pharmacists and their clinical teams will need to ensure that maximum
effort is focused on these activities.
References
1. Lawson W, Ridge K, Jacklin A, and Holmes A. Infectious diseases pharmacists
in the UK: promoting their role and establishing a national network.
Journal of Infection 2000;40: A31.
2. Department of Health. Saving lives: antimicrobial prescribing, a summary
of best practice. London:The Department;2007.
3. Hand K. Antibiotic pharmacists in the ascendancy. Journal of Antimicrobial
Chemotherapy 2007;60:i73–6.
4. Cooke J (on behalf of the prescribing subgroup of SACAR). Appendix
2. Specialist Advisory Committee on Antimicrobial Resistance (SACAR)
antimicrobial framework. Journal of Antimicrobial Chemotherapy 2007;60:i87–90.
5. Department of Health. Saving lives: reducing infection, delivering
clean and safe care. London:The Department;2007. |
Hospital Pharmacist