Reducing reliance on CIA’s

Welcome to the third case study of antimicrobial stewardship in equine practice. In this example, we have a practice manager doing a routine stock check, and they notice that the sales of ceftiofur and enrolfloxacin were high, yet the sales of TMPS and doxycycline were low. The practice manager informed the senior partner who called a practice meeting to discuss antimicrobial use.

In the meeting, they discussed lots of different things, and they decided that on a practice level, they needed to develop some practice protocols and work on some evidence-based dosage determinations, have a think about which types and brands of antimicrobials they were going to keep in stock. They decided that with the seemingly high sales and protection antimicrobials, what they should do is utilise the BEVA Protect Me web pages and use the logbook to record the sale of protected antimicrobials, such as ceftiofur. And they also implemented a protocol for culture and sensitivity being required prior to the prescription of protected antimicrobials.

The practice manager also decided that ambulatory vets would not be able to carry protected antimicrobials in their cars because in an ideal world, they should only be used second line or in response to positive culture and sensitivity. And therefore, vet should have advance warning and notice to be able to put stock in their cars if required. The senior partner also implemented multi vet authentication for the prescription of protected antimicrobial whereby if a vet wanted to prescribe such a protected antimicrobial enrolfloxacin or ceftiofur, they had to have approval from any other vet in the practice. It didn’t necessarily have to be the practice partner, but they needed multi vet authentication. And this was logged in the logbook.

They also scheduled a second practice meeting to review their protocols in three to six months time and develop some client information sheets on protection of antimicrobial resistance and antimicrobial stewardship, which they uploaded to their practice website. On an individual vet level, keeping knowledge up to date was discussed, and CPD requirements were discussed amongst the practice staff. And it was also determined that regular clinical meetings would be held, particularly with regards to common cases seen in the practice and antimicrobial prescription. The staff were encouraged to make conscious choices, not tired ones.

And I know we’ve all been there where tiredness has got in the way with what perhaps had been a very, very long day and couple that with low car stock, for example, if you’ve run out of a certain type of anitmicrobial, you may feel forced into prescribing another one. But if your car stock is checked regularly, then hopefully, that should not be a problem. And protocol sheets were also printed off to be kept in the cars for the vets to use if they were unsure, and client information sheets were also printed off to be given to clients at the time a prescription or not prescription as it may be.

As always, if you have any questions, please feel free to contact us.