Grow-Your-Own Antimicrobial Stewardship Culture

Veterinary Prescriber presents this practical toolkit for creating a culture of antimicrobial stewardship in the veterinary practice, in five parts: introduction; step 1; step 2; step 3; getting started. The series has also been published as a single module in Veterinary Prescriber’s Virtual Veterinary Medicines Academy. Continue the series here with step 1. The series (like our modules) includes audio, so you can read while you listen. The module was created by Veterinary Prescriber in collaboration with Simon Robinson of Operability.

Antimicrobial stewardship is not simply about following policies and prodedures, because these are unlikely to succeed without a conducive environment. In this Veterinary Prescriber module, we are using the concept of a petri dish to illustrate the three conditions (represented by three ‘microorganisms’) that are needed in the veterinary practice to promote an environment in which staff can practice antimicrobial stewardship. Our module will guide you through the process of building a good antimicrobial stewardship culture. The first condition for growing a good culture of antimicrobial stewardship culture is to apply good practice, to monitor and improve.

1. Apply good practice, monitor and improve

The first condition for growing a good culture of AMS is to apply good practice, to monitor and improve. Veterinary practice has learned a lot about effective AMS from human health, and more veterinary-specific information is being published all the time. Here are some simple things you can do to start growing your AMS culture:

Visibly demonstrate leadership commitment to AMS

Leaders, owners and managers at practice or corporate level all influence the attention and importance given to AMS culture.  When leaders show a clear commitment to reducing antimicrobial resistance, staff know that it is important to the practice, and that they will have the support of their organisation when they make difficult choices in relation to prescribing antimicrobials 

Leaders can talk to staff about their own personal commitment to AMS, and become an “antibiotic guardian” by committing to a pledge. You can do this by following the link.

Appoint an AMS champion or team

Antimicrobial stewardship champions help implement interventions and think proactively about safeguarding antimicrobials in the practice. Allocate time for champions or team members to participate to show that it is a core activity of practice business.  Ensure their commitment to AMS is recognised and valued in your practice, and that their recommendations are supported by the practice leadership.

Gather good practice information and resources 

There is a wealth of helpful information on AMS in the veterinary sector. Here are some resources (with internet links):

• BSAVA/SAMSoc PROTECT Me resources: A large source of information and tools, originally targeted at small animal practice but adopted by other species groups

• RCVS Knowledge AMR Hub: Lots of valuable resources on AMS

• VET Sustain:  Advice on using medicines responsibly

• BEVA: PROTECT Me Toolkit

• Veterinary Prescriber: modules on selecting antimicrobials for ear and eye infections and advice on rational use of medicines in general. Sign up for a practice subscription with the code VETRxPRACTICE.

• GRAM: Guidance for the Rational Use of Antimicrobials

• AMR Vet collective: learning modules on AMS

The PROTECT ME Poster

Developed by BSAVA and SAMSoc helps practices assemble an AMS strategy, including:

• Principles to guide decisions on AM use

• Situations where AMs should not be routinely prescribed

• Diagnostic pathways for specific conditions

• The name of your Antibiotic Champion for the practice

Evaluate what the practice already does

Understand what AMS protocols and guidance you already have in the practice.  If you are a participant in the RCVS Practice Standards Scheme you may already be benefiting from the scheme’s requirements and guidance on AMS (see below).

RCVS Practice Standards Scheme

The Practice Standards Scheme suggests  practices have:

• A protocol on prescribing antimicrobials in common conditions

• A written policy on prescribing highest priority clinically important antibiotics

• Procedures to educate staff and clients about AMS

Find out what protocols you already have, and how helpful they are.  Update them if necessary, and familiarise team members with them. Formalise a pathway for reviewing and updating them regularly.

Measure and identify areas for improvement

Measuring antimicrobial drug use provides a baseline and highlights scope for improvement. It can identify situations or patterns where antimicrobial prescription is especially high. It can also give insight into the effectiveness of AMS interventions and alert the practice to sudden or drastic changes in prescribing habits. These are examples of things you might choose to measure:

• Review purchases of antimicrobials.

• Review the prescriptions for antimicrobials in the practice over a period of time.

• Review patient histories for incidents of prescribing for wound and surgical site infections, that might indicate hospital-acquired infection and breaks in biosecurity.

Try to involve all staff and use the different skills and knowledge in the team. For instance, a practice manager might conduct a client survey, while the clinical team might review antimicrobial supplies and purchases, reporting the most common drug-resistant pathogens seen in the practice.

The information collected from your research might point you in a clear direction for improvement. For example, if data collected on antibiotic sales shows a high use of quinolone antibiotics you might choose to examine that more closely, or conduct an audit, to find out why.  

Now click the second image to go to Step 2.

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