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 2. 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 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 second condition for growing a good antimicrobial stewardship culture is to build staff understanding and engagement.

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 2. Build staff understanding and engagement

The second condition for growing a good AMS culture is to build staff understanding and engagement. This means ensuring all the members of the team to understand AMS and play a part. A successful practice needs to:

  • Discuss the AMS approach with staff

  • Understand what really happens in the practice

  • Agree consistent approaches.

Discussing AMS with your staff

There are lots of training and familiarisation materials available to help you do this (see resources in Step 1).  The BSAVA/SAMSoc PROTECT ME principles are a particularly helpful way of talking about AMS and what it is trying to achieve.

Have a conversation about the principles, and how staff may have an influence over their application.  Every member of the team will have some role to play. Make AMS protocols a part of every-day practice, empowering staff and keeping the challenge in the forefront of people’s minds. 

PROTECT ME is an acronym made up of the first letter of a list of principles that should be considered BEFORE prescribing antibacterials. These are:

  • Prescribe only when necessary

  • Reduce prophylaxis

  • Offer other options

  • Treat effectively

  • Employ narrow spectrum

  • Culture appropriately

  • Tailor practice policy to patients

  • Monitor culture results

  • Educate others”

Source: BSAVA/SAMSoc Guide to Responsible Use of Antibacterials: PROTECT ME (2018)

Understand what really happens in the practice

Existing practice policies and procedures may be unhelpful or difficult to apply, or simply not practical in real-life situations. Talk about what works and what is difficult to follow, not just what the policies say should be happening.

Talking about real-life dilemmas that staff face can reveal issues that can be fixed, benefiting everybody.  For instance, a discussion about the principle “Reduce Prophylaxis” may prompt surgical staff to talk about the practice policy of using antimicrobials as surgical prophylaxis, and whether there could be changes to pre/ peri/ post-surgical hygiene instead.

A discussion about the use of antimicrobial sensitivity testing might raise issues about the logistics of getting results in a timely manner, and the prescribing approach to take while waiting for results

Agree consistent approaches

An important purpose of the team discussions is to come to a consensus agreement on appropriate antimicrobial prescribing.

The PROTECT ME poster is extremely useful for this, with a selection of commonly encountered conditions and space for practices to record the agreed antimicrobial approach.  There is no “right” answer, and no intention to undermine clinical judgement, but it does give clinicians reassurance that their decisions are backed by practice consensus.  You may also want to discuss specific tactics that reduce the need for antimicrobial prescription, including the use of diagnostic testing, or a “watchful waiting” approach. 

Now click the third image below to go to Step 3.

 
 

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