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10 January 2019

Antimicrobial stewards prescribing change at Broomfield

Toby Stock and Lauren Shillito - antimicrobial stewards
Toby Stock and Lauren Shillito - antimicrobial stewards

Antimicrobial stewards at Broomfield Hospital are behind an innovative scheme, believed to be the first in the UK, to ensure antibiotics are prescribed more intelligently. 

Lauren Shillito and Toby Stock, who both have degrees in psychology, have been compiling and analysing data around prescriptions and their work is already reaping benefits.

Since the pair started work in July 2018, Broomfield has seen a 22% decrease in antibiotic consumption, a 25% increase in IV antibiotics being reviewed between 24 – 72 hours, and hospital-wide compliancy with local prescription guidelines has reached a high of 82%.

Lauren and Toby work with consultant microbiologist Dr Wael Elamin and antimicrobial pharmacist Imran Ali to analyse clinical behaviours.

Lauren explains: “We’re trying to change behaviours, to make people think about why they’re prescribing certain drugs, and to think about the effect of having these reviews. It’s not about enforcing rules, it’s highlighting the ‘why?’ in the hope that will help people to change their behaviour in a way that will benefit patients.

Toby added: “We measure the antibiotic consumption in the hospital though DDDs – daily drug dosage. It’s a standardized unit across all different antibiotics and course lengths.

“The surgical division is our greatest success story and where we see our most consistent results. In terms of compliance with local guideline, general surgery has risen from around 40% to consistently above 80%.

Dr Elamin was full of praise for Toby and Lauren: “‘They have made a massive contribution and I’ve learned a lot from them myself. We think this is expandable to other specialities because a lot of the problems in the NHS are behavioural rather than clinical.

“Antibiotics are probably the third most expensive drugs we use in a hospital. About one in every three patients is on antibiotics. You’re exposing patients to fewer antibiotics, with the probability of less side effects, and you’re not treating patients unnecessarily. You save money and patients will be able to go home earlier.

Antibiotic resistance is rated second only to terrorism as a threat to national security and after being late to sign up the government’s CQUIN targets for reducing antibiotic consumption, the team now hope Broomfield can become an example to other Trusts. 

Toby and Lauren were unsure how clinicians would react to two non-medical staff making suggestions about their working practices but have been pleased about how open-minded they have been. “Without the clinical teams’ input this wouldn’t be possible. Their behaviours are perfectly normal, human behaviours, but sometimes they just need more opportunity for reflection,” said Toby. Lauren added they were “helping clinical teams reach their own conclusions”.

Dr Elamin thanked senior management for the support he’d received in being able to recruit Lauren and Toby, but stressed how important it is for behavioural change to be long-term: “It’s an ongoing project. We always reflect on what goes right and wrong and where we can improve. But the momentum has to continue.”