Policy/Programme suggestions for vet practices/vet hospitals

When setting up an antimicrobial stewardship programme or policy (ASP) thought needs to be given to who is in charge, who sets policies, what outcomes are measured, and who monitors these.

Discuss why an ASP is required and how each person can contribute to its success.

Make a practice wide commitment that an ASP is a priority for all practice staff (including reception staff who can champion it with clients), focusing positively on optimisation of antibiotic use and protection of antibiotics.

• Use as little as possible but as much as necessary.

Discuss prescribing habits within the team and decide on priorities (such as monitoring antimicrobial use, resistance patterns, training requirements, which antibiotics can and cannot be used, what proportion of cases are to be sampled).

The ASP should contain a statement of which issues are to be addressed, keeping these simple and achievable, possibly:

• Reducing quantity of critically important antibiotics. 
• Increasing the proportion of cases where narrow spectrum antibiotics are used instead of broad spectrum antibiotics.
• Increasing the number of cultures carried out.
• Where appropriate, delaying treatment until sensitivity results are available.

Agree interpretation of “under direct clinical care” among vets in practice (RCVS definition).

For consistency and support of less experienced or new team members, agree policy on:

• repeat prescriptions for antibiotics
• how  much can be given to farm clients at one time

Encourage and promote investigation of underlying causes ,for example using cytology and near patient diagnostic tests to avoid unnecessary or inappropriate antibiotic use.

Agree policy on antibiotic use around surgery and oncology.

 

Organisation

Identify a lead person (champion) to be responsible for co-ordination of the stewardship programme, a vet or a nurse, or a multidisciplinary team composed of a co-ordinator and a lead from each sector may be appropriate in large or mixed practices.

• The role(s) requires:
  • sufficient knowledge in AMR and therapy
  • sufficient time to oversee the programme

• All staff must be accountable

 

Monitoring

An essential element of any antibiotic stewardship programme (ASP) is identification of measures of outcome appropriate for the individual vet practice.

Antimicrobial usage (AMU) could be used as an internal benchmark for the vet practice. The RCVS AMR Hub provides further supporting information. 

Experience from human medicine suggests that some of these simple examples could help to inform individuals within the practice.

• Total practice antibiotic use can be determined from sales data.
• Monitor and review the amount of use of Critically Important Antibiotics (CIAs) which may impact on human health.  These might include:
  • criteria for use (for example, only when supported by culture and sensitivity, only for specified diagnoses)
  • protected use (for example, keep log to enable peer review, separate red or colour-coded storage shelf or area in practice as reminder, not carried in vets’ cars)
• Monitor amount of use of specific antibiotics, for example quinolones and third/fourth generation cephalosporins:
  
  • on a quarterly basis, these could be as simple as the amount sold
  • over time, trend analysis will be possible and changes in practices detected
  • gives an easy way of checking whether interventions have desired outcome
• Antimicrobial usage against treatment guidance policy to identify areas for improvement (perhaps good experience for trainee nurses).
• A good ‘practice bundle’ for antibiotic use to allow comparisons to be made across similar sectors and provide individual vets, the practice and wider community with data for reflection on prescribing habits, might include:
  • indication
  • dose
  • course length
  • review required or not
• Peer review antibiotic cases, considering:
  • % cultures submitted to the lab
  • % cultures with resistant organisms
  • Whether indication recorded in animal record
  • Whether topical treatment could have been employed
  • Course length given – discuss optimum
  • Dose used – discuss optimum

 

Helpful resources

• Top tips on reducing the use of antibiotics from British Equine Veterinary Association, including short YouTube videos from practitioners.

• Alongside the PROTECT ME poster, BSAVA have developed a form (No antibiotic required ‘non prescription’ form) that can be provided to clients to support a decision not to provide antibacterial medication