NHS organisations should set up “antimicrobial stewardship teams” to review and question the local prescribing patterns of nurses and doctors, according to draft guidance.
The National Institute for Health and Care Excellence has for the first time published draft guidelines aimed specifically at helping tackle the growing threat of antimicrobial resistance.
The guidance recommends that local commissioners and providers establish their own antimicrobial stewardship programmes and form antimicrobial stewardship teams to oversee them.
The teams should review prescribing and resistance data and identify ways of feeding this information back to prescribers in all care settings, according to NICE.
This draft guidance recognises that we need to encourage an open and transparent culture that allows health professionals to question antimicrobial prescribing practices of colleagues
The teams should also provide education to prescribers in all care settings, assist the local formulary decision-making group with recommendations about new antimicrobials, and update local formulary and prescribing guidance.
In addition, they should work with prescribers to investigate reasons for “very high, increasing or very low volumes” of antimicrobial prescribing, and provide feedback and assistance to those prescribing antimicrobials outside of local guidelines, where it is not deemed justified.
NICE said its draft medicines practice guideline on antimicrobial stewardship was intended to help health and social care commissioners, providers and prescribers “promote and monitor the sensible use of antimicrobials to preserve their future effectiveness”.
Professor Alastair Hay, chair of the committee which developed the guideline, said: “This NICE guideline considers the whole area of antimicrobial prescribing.
“It looks at the evidence and makes recommendations for health and social care practitioners and organisations on the best ways to minimise antimicrobial resistance.”
Professor Mark Baker, director of the NICE Centre for Clinical Practice, said: “This draft guidance recognises that we need to encourage an open and transparent culture that allows health professionals to question antimicrobial prescribing practices of colleagues when these are not in line with local and national guidelines and no reason is documented.”
“But it’s not just prescribers who should be questioned about their attitudes and beliefs about antibiotics”, he said, noting that was often patients themselves who put pressure on clinicians to prescribe an antibiotic due to a lack of clinical understanding.
“The draft guideline therefore recommends that prescribers take time to discuss with patients the likely nature of their condition, the benefits and harms of immediate antimicrobial prescribing, alternative options such as watchful waiting and/or delayed prescribing and why prescribing an antimicrobial may not be the best option for them – for example, if they have a self-limiting respiratory tract infection,” said Professor Baker.
National antibiotic charts, published by NHS Prescription Services, show that overall antibiotic prescribing in the community in England has been steadily increasing over several years.
Overall, 41.6 million antibacterial prescriptions were issued in 2013-14 at a cost to the NHS of £192m.
Dr Maureen Baker, chair of the Royal College of GPs, highlighted that members of the practice team could come “under enormous pressure from patients to prescribe antibiotics”.
“It is essential that GPs, their practice teams and pharmacists discuss the alternatives with patients who ask for antibiotics to treat minor illnesses, most of which will get better on their own over time,” she said.
The instititue is due to finalise its guidance on antibiotics by the end of July this year.
NICE is also developing a public health guideline that will focus on changing people’s knowledge, attitudes and behaviours in relation to the use of antimicrobials.