The aim of our evidence-based audit and feedback (A&F) quality improvement project is to influence clinical behaviour of prescribers to deliver a better quality of care and support antibiotic stewardship. Our innovative approach has proved to be scalable across the whole the West Yorkshire and Harrogate Integrated Care System (ICS).
As well as working with our academic colleagues from the University of Leeds our project also has input from local prescribing and medicines optimisation leads, public health, infection control teams and the Yorkshire and Humber Academic Health Science Network (AHSN). Our ICS CCGs support this work as a contribution to the implementation theme across the National Institute for Health Research (NIHR) Yorkshire and Humber Applied Research Collaborative (ARC). The project has taken a fully collaborative approach by providing briefings to community pharmacy and lead pharmacists in each of our ICS trusts to make them aware of the project and the clinical areas to be considered.
An NIHR-funded research programme (Foy et al 2015) developed and evaluated an enhanced A&F intervention to reduce risky prescribing in general practice. The study showed a positive population effect in the results. Using these enhanced feedback techniques the West Yorkshire Research and Development (WYR&D) team hosted by NHS Bradford district and craven Clinical Commissioning Group (CCG) set up a transformational quality improvement project to Lower Anti-Microbial Prescribing (LAMP) across the ICS general practices. The project includes all prescribing of antibiotics in general practice and so includes patients that are care home residents.
In January 2019 the Department of Health and Social Care announced a new 5 year strategy with an aim to champion responsible use of antibiotics, by ensuring NHS staff have the skills, knowledge and training to prescribe and administer antibiotics appropriately. From April 2019 the WY R&D team started to send all the 317 general practices across our ICS bi-monthly audit and feedback reports on the prescribing of antibiotics within their practice. The project forms a large part of the ICS Anti-Microbial Resistance (AMR) community response and is contributing to one of the 10 ICS main ambitions.
The extracted data is aggregated and anonymised and is fully GDPR compliant. The areas highlighted were agreed collaboratively by pharmacy leaders and academic GPs. We feedback prescribing data every eight weeks and ask practices to review their current antibiotic prescribing for common infections. The reports include behaviour change techniques (Brehaut et al 2016) with persuasive messaging; local susceptibility data provided by Public Health England, references to the latest guidance, sample action plans, and practice audit frameworks along with answers to questions tackling antimicrobial resistance. A Learning Tool Box (LTB) digital platform and app (Dennerlein et al 2014) is being utilised in an attempt to increase the spread of high quality evidence to all practice staff and prescribers to support them with the advice they give and prescribing decisions they make.
