Successful Implementation of Antibiotic Stewardship

Hello. My name is Elizabeth Beech. I work as a National Project Lead for antimicrobial resistance based on the patient safety team at NHS improvement. And I’d like to welcome you to Churchill Medical Centre here in Kingston in London who provide care to 25,000 patients. Churchill Medical Centre won a NICE shared learning award in 2014 for a whole practice approach to improving the way they manage respiratory tract infections in patients.

This was based on the nice guidance that was published along a similar theme, and we’re here today to talk to various members of the practice about the approach they took, how they developed this strategy, and what it’s meant for improving patient care and ensuring the appropriate prescribing and use of antibiotics. Hi, I’m Dr. Peter Smith. I’m Senior Partner at Churchill Medical Centre in Kingston. We are a practice of 25,000 patients, and we operate across four sites. We have around 20 GPs and nursing teams at least eight at any one time. Several years ago, before the days of TARGET in a different era, we, as a team, decided that the issue of antibiotic prescribing was one that we wanted to address.

Everyone was particularly concerned that there was not a consistent message going across to patients that patients were tending to hop from one GP to another in the hope of getting an antibiotic, which they didn’t need in the first place. And although the evidence is very clear that antibiotics were not required, there was a concern at the time from GPs. That medical legally, they felt they might be at risk if they’re refusing an antibiotic, and a patient then ran into a problem and complained. So there are a variety of reasons why we decided to start to do something about that. But we particularly started by saying where is the evidence behind this? If it really is so strong, where is it?

What we happened upon at the time was a NICE guidance, which is very, very clear and uniquely for guidance around antibiotic prescribing. It included the duration of illness, and we decided we were going to have a very positive campaign, which we were going to base around self-care because that’s been both mine and various other doctors’ interest. We were going to have a programme that was going to present positive messages to patients about self-care and about why antibiotic treatment was actually worse than self-care and also around the duration. So we were going to concentrate just on a couple of elements of a programme and devise it ourselves.

We took a multiprofessional approach and multidisciplinary approach where we had a team, which included GPs, nurses, receptionists, and admin staff, so that everybody that might be affected by this programme was involved from the start, and that we would have consistent messages. I have to say everybody wanted to be part of it. But in order to make it work, we had to have a group of champions that had to basically lead the way. All you have to do to be a champion– you have to be someone that’s prepared to be consistent and give exactly the same message and to be upbeat and enthusiastic about it– that’s all that’s required.