Implementation support

Resources for championing practice-wide implementation

Who are these resources for?

The resources on this page are for anyone who wants to promote/champion the prudent use of antibiotics in their own general practice, their Primary Care Network, or in practices within their Clinical Commissioning Group.

You may want to identify a practice-based Antibiotic Champion. This could be a prescribing lead, GP with a specialist interest in infection management, nurse practitioner, clinical pharmacist, or any other person who can be responsible for antimicrobial stewardship in your practice, your Primary Care Network, or the practices within your Clinical Commissioning Group.

If you are an Antibiotic Champion, you could ask a colleague to help you carry out some of the activities. This helps to share any additional workload and enables others in the practice to ask for help more easily if the champion is unavailable.

 

What is the purpose of these resources?

This Antibiotic Optimisation website aims to help implement and promote the uptake of three effective and safe strategies to reduce inappropriate antibiotic use: (1) enhancing discussions with patients, (2) using POC CRP tests, and (3) using back-up/delayed antibiotic prescriptions.

 

This page has resources for Antibiotic Champions

  • to promote the use of these strategies in their practice, and
  • to encourage prescribers to engage with this website.

Resources for championing the three strategies

Below is a brief summary of the key information on why prescribers and practices may benefit from using the three strategies.

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For more details go to: Discussing antibiotics - finding the right words.

Why do it?

  • To address patient concerns in a way which works for patients - especially as prescribers may over-estimate patient expectations for antibiotics and what prescribers say to patients may be misinterpreted by patients.
  • The examples provided are quick and easy to incorporate into consultations.
  • The tips provided may be particularly helpful to manage discussions with patients who expect antibiotics when they are not needed.

Addressing common questions and concerns:

  •  Prescribers already use/know communication skills so what does this website add?
    • Prescribers often over-estimate patient expectation for antibiotics so asking specifically about them may help to clarify what the patient wants, and in turn improve patient satisfaction.
    • Sometimes patients may interpret what prescribers say in a different way to that intended. For example, telling a patient that they likely have a viral infection may make them feel 'fobbed off'.
    • It can be helpful to see example techniques that other prescribers have found helpful. For example, discussing the usual duration of common infections is usually very helpful and explaining that antibiotics will not shorten the length of illness.
  • There is insufficient time in consultations
    The examples provided as part of CHESTSSS are short sentences that can be incorporated into what prescribers already do and say in consultations.
     
  • How to deal with 'difficult' patients?
    Going through the elements of effective consultations (CHESTSSS) can be especially helpful with patients who are particularly concerned about their illness or who expect antibiotics. For example, providing non-serious explanations for symptoms,explaining how long infections normally last, and explaining shortcomings of antibiotics can help address patient concerns and reassure them.
     
  • Some patients have limited language skills
    Patient leaflets in many different languages and pictorial format are available on the TARGET toolkit and may be used if needed in these situations.

For more details go to: Using POC CRP tests.

Why use it?

  • POC CRP is particularly helpful in cases of clinical uncertainty as it provides additional diagnostic information and helps differentiate serious illnness (e.g., pneumonia) from self-limiting infection.  
  • It helps safely reduce antibiotic prescribing. (Trials show it is an effective and safe strategy).
  • It is quick and easy to use (max 5 minutes to get a result).
  • It provides feedback to a prescriber on their clinical judgements and helps reflect on their "gut feelings".
  • It can be taken and used during home visits or in nursing homes.

Addressing common questions and concerns:

  • Using CRP tests may increase patient expectations for the tests and consultations
    To minimise the risk of this happening POC CRP should be used in situations of clinical uncertainty as an additional tool to help prescribers decide whether patients need antibiotics. Prescribers should explain to patients why they are using the test in these situations (examples provided in CHESTSSS can help with that).
     
  • There is insufficient time in consultations to do POC CRP tests
    Both Afinion and SureScreen POC CRP tests provide the results in under 5 minutes.
     
  • How reliable / sensitive are POC CRP tests?
    You can read about performance characteristics in the Afinion package insert (p. 12) and in the SureScreen package insert. Both Afinion and SureScreen CRP tests have been approved for use in the UK and are CE-marked (showing that they meet the requirements in the Medical Devices Directive). While the Afinion analyser shows relatively good sensitivity and specificity against laboratory results across the range of results, a recent independent validation suggests that SureScreen CRP test does not have good sensitivity for detecting samples with high CRP levels (over 80) compared with moderate CRP values (10-80). It does have good sensitivity for detecting samples with CRP levels under <10 vs. >10 and <40 vs. >40. Please refer to the SureScreen page to find out how to take it into account when using the SureScreen CRP test.

 

For more details go to: Using back-up/delayed antibiotic prescriptions.

Why use them?

  • Reduce re-consultations more effectively than immediate antibiotics (saving both patient and practice staff time).
  • Prevent complications as effectively as immediate antibiotics.
  • Reduce antibiotic use - only 33%-39% of patients use antibiotics when given a back-up/delayed prescription.
  • Increase patients ability to self-manage their infection (patients report no significant worsening in the duration of illness or experience of pain).
  • Reduce future consultations for similar illnesses.

Common questions and concerns:

  • How long does it take to explain?
    Using the examples provided it takes less than a minute to explain a back-up/delayed prescription.
     
  • Will this give a mixed message to patients about whether antibiotics are beneficial?
    Using the examples provided you can explain to patients that they are allowing time for their immune system to fight the infection and only using antibiotics if symptoms do not improve.
     
  • Will patients know how long they should wait before starting antibiotics?
    It is most useful for patients if you can specify the number of days that they should wait before using the antibiotics, rather than saying "a few days".
     
  • Will patients just take the antibiotics straight away?
    Research has shown that when a back-up/delayed prescription is explained well, patients use antibiotics approximately 30% of the time.

Providing a good explanation of a back-up/delayed prescription to patients will help to address these concerns.

If you are certain that the patient does not need antibiotics, you can discuss antibiotics using the right words to provide a good explanation and reassurance on why antibiotics are not necessary.

You can remind patients to return any unused medicines to a pharmacy for safe disposal.

The first, introductory practice meeting is to:

  1. Increase interest and awareness among prescribers about the Antibiotic Optimisation website.
  2. Introduce the three strategies and associated resources for prescribers on this website.
  3. Facilitate discussions around when and how each strategy will be used within your practice.

The meeting should be held with all staff, or at least all prescribers, in your practice. If difficult, you may need to organise more than one meeting, talk to prescribers unable to attend the meeting individually and send copies of the meeting slides.

You can download the introductory practice meeting slides (power point) and adapt them if needed.

 

Subsequently, review practice meetings held every 2-3 months can help to:

  • Review use of the strategies according to the needs of your patients and practice staff.
  • Remind prescribers, and/or update new or locum staff, in your practice about the strategies being used.

You can download the meeting slides focused on each of the three strategies:

  1. Finding the right words to discuss antibiotics (power point)
  2. Using POC CRP testing (power point)
  3. Using back-up/delayed antibiotic prescriptions (power point)

 

A list of all downloadable support materials mentioned here is available on the Resources page.

 

Discussing antibiotics:

  1. Encourage prescribers to read the examples of things to say to patients provided on the website or look at the Top tips summary (pdf).
  2. Ensure that copies of patient leaflets are available in all consulting rooms.
  3. You can upload the leaflets on your electronic clinical system (instructions are available on the TARGET toolkit) or save the pdfs of leaflets on computer desktops.

 

POC CRP testing:

  1. Arrange training in using the Afinion analyser with the Abbott team and ensure all staff using the analyser are trained in using it and have the required competencies (as advised by the Abbott team).
  2. Print and display the summary sheet for interpreting CRP test results in suitable places (e.g., near the Afinion analyser, in consultation rooms).
  3. Ensure all prescribers complete the training task: i.e., use each type of CRP test on 5 patients presenting with RTIs and record the results of the Afinion test on the summary sheet for recording Afinion CRP results - print it and display it next to the analyser. You can record which prescribers have completed the training.
  4. Set a procedure for, and ensure that, the Afinion analyser is switched on and set up every day (see online training videos modules 2 and 3).
  5. Ensure that the quality control tests on the Afinion analyser are conducted as advised by the Abbott team.

 

Back-up/delayed antibiotic prescriptions:

  1. Ensure printed copies of a reminder sheet for back-up/delayed antibiotic prescriptions are available in all consulting rooms.
  2. Ensure the codes for back-up/delayed antibiotic prescriptions are available on the clinical system.
  3. Encourage prescribers to code back-up/delayed prescriptions.
  4. Encourage prescribers to use the relevant section on the TYI leaflet when using back-up/delayed prescriptions to give patients clear information.