Patient safety spotlight: how pharmacy teams can help minimise antimicrobial resistance
In an article introduced by our CPhO Clinical Fellow Aileen O’Hare, Dr Diane Ashiru-Oredope and Eleanor Harvey from the UK Health Security Agency identify the risks of prescribing and dispensing oral antimicrobials and consider how pharmacy teams can minimise antimicrobial resistance.
Over the past six months we have received several concerns from members of the public in relation to the prescribing and dispensing of oral antimicrobials by pharmacist independent prescribers (PIPs) employed by online pharmacies.
The inappropriate prescribing of antimicrobials by prescribers could contribute to antimicrobial resistance (AMR). This article developed with Dr Diane Ashiru-Oredope and Eleanor Harvey from the UK Health Security Agency aims to provide a background to AMR and identifies antimicrobial stewardship (AMS) tools that pharmacy teams can utilise to optimise prescribing and dispensing.
Why is AMR important?
The Global AMR Review Study highlighted that 700,000 people die of AMR infections each year and that without urgent action, the death toll could rise to as many as 10 million deaths annually by 2050. The World Health Organization declared AMR one of the 10 global health issues facing humanity in 2021.
On 20 January 2022, a systematic analysis on the Global burden of bacterial AMR highlighted that AMR is now a leading cause of death worldwide. It was estimated that 1.2 million people died from antibiotic-resistant bacterial infections in 2019- more than HIV/AIDS or malaria.
COVID-19 is also exacerbating AMR due to overuse of antibiotics; 70% of patients diagnosed with COVID-19 infection were prescribed antibiotics despite co-infection of COVID-19 and bacterial infection only being present in 6.9% of the patient cohort.
Data from the English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) shows that in secondary care, antibiotic prescribing rates, especially of antibiotics of last resort, increased by 4.8%. The proportion of resistant bloodstream infections has increased by 5% since 2016.
From 2019 to 2020 dental antimicrobial prescribing in Primary Care increased by 17.6%. Reducing inappropriate prescribing and use of antimicrobials is essential to tackling antimicrobial resistance.
How can pharmacy teams contribute to Antimicrobial Stewardship (AMS)?
Pharmacist independent prescribers (PIPs) in primary care can contribute by involving patients in shared decisions about treatments of illnesses, including considering delayed prescriptions or offering backup prescriptions if symptoms do not improve.
The Royal Pharmaceutical Society’s policy on the pharmacy contribution to antimicrobial stewardship focuses on the pharmacist’s role as part of a multidisciplinary approach in tackling the challenges of inappropriate use of antibiotics. The recommendations align with the challenge set by the UK Government of reducing inappropriate antibiotic prescribing and the recent overprescribing review.
Guidance from the RPS suggests encouraging people to manage self-limiting conditions themselves and speak to their local pharmacy team. They highlight that community pharmacy is well placed to educate people on the safe and effective use of antimicrobials by:
- highlighting the difference between a viral and bacterial infection
- advising on the average duration of common self-limiting conditions to reassure the person thereby reducing the risk of inappropriate antimicrobial prescriptions being prescribed
- counselling patients using TARGET leaflets when patients consult with self-limiting infections
- offering explicit advice on what to do if the symptoms get worse (such as safety-netting)
- recognising warning symptoms or when someone may need antimicrobials and refer where needed
The UK Health Security Agency team suggests additional resources and tools that pharmacy teams could access to spread awareness and stop resistance, including:
- choosing a pledge on the Antibiotic Guardian Website to support improved use of antibiotics
- obtaining a copy of your local antimicrobial/antibiotic formulary from your Area Prescribing Committee and online pharmacy services should consider their geographical reach. Consider national guidance such as NICE and SIGN when providing services across the UK
- completing a free online training course,for example AMS for community pharmacy
- engaging with European Antibiotics Awareness Day and/or World Antimicrobial Awareness Week
- carrying out an audit of your AMS activity
- speaking to local schools about reducing the spread of infection. Use the E-Bug teaching project for children aged 7-16
- using the Antibiotic checklist for community pharmacy to support appropriate antibiotic patient counselling
- aligning antimicrobial sexual health prescribing to BASHH guidance
Online pharmacy prescribing services
Online pharmacy prescribing services should:
- consider how antimicrobials are displayed on the online pharmacy website
- minimise the patient’s ability to make an antimicrobial selection inappropriately
- prioritise patient centred consultations which facilitate optimal antimicrobial prescribing decisions
- consider the risks of supplying antimicrobials remotely
- regularly review antimicrobial prescribing performance
Pharmacy teams should refer to the GPhC guidance for registered pharmacies providing pharmacy services at a distance including on the internet, to tackle AMR.
AMR is an important patient safety and public health problem. You can play your part in tackling AMR by reducing inappropriate antibiotic prescribing and support patients to prevent infections. There are various resources at your disposal, some of which are highlighted in this article – spread awareness, stop resistance!