PrescQIPP

Pioneering antimicrobial stewardship in community-led urgent care (2025)

NEMS CBS

Project summary

The NEMS Pharmacy Team, part of a social enterprise delivering NHS services, launched a pioneering antimicrobial stewardship project at the Urgent Treatment Unit (UTU), Queen’s Medical Centre (Nottinghamshire), in response to a rapid rise in patient numbers—from 80 to 120 daily—after transitioning to Urgent Treatment Centre status. As patient volumes increased, the frequency and complexity of antibiotic stock discrepancies also rose, requiring multiple investigations and highlighting significant patient safety risks. This was compounded by the fact that antibiotics were dispensed by GPs, nurses, or paramedics without a dedicated on-site pharmacy team, and pharmacy staff rotated between three 24/7 sites.

To address these escalating challenges, we implemented a comprehensive, multi-pronged strategy:

  • Targeted posters and bespoke education sessions, co-designed with consultant microbiologists, were delivered and recorded to upskill urgent care clinicians, PCN clinicians, and ICB clinical staff ahead of the winter period.
  • Bespoke antibiotic pack sizes, introduced from April 2024, ensured adherence to local antimicrobial guidelines and appropriate course lengths (e.g., Doxycycline 100mg 6 caps).
  • Persistent discrepancies and the lack of continuous pharmacy oversight led to the removal of TTO antibiotics from stock in October 2024. Urgent antibiotics are now supplied via Trust/community Pharmacy for pharmacist review. For non-Trust co-located sites, solid oral TTOs can be removed, with STAT doses available for acutely unwell patients and follow-up prescriptions for community pharmacy collection.
  • Customisable self-care notes, rolled out before Christmas 2024, supported clinicians in managing patient expectations and reducing unnecessary antibiotic and FP10 prescribing. Pharmacy First information was included to promote self-care.
  • Adoption of the Adastra system with embedded EPS enabled secure, auditable electronic prescribing, eliminated reliance on paper prescriptions, and reduced time spent on stock reconciliation from up to 6 hours per fortnight to zero.
    Outcomes and impact
  • Antibiotics are now provided through pharmacies, reducing errors and ensuring professional advice. No complaints were received after TTO removal, and inappropriate prescribing is now quickly identified and escalated.
  • Antibiotic use was reduced by 966 packs over 30 weeks, with a significant reduction in medicines waste.
  • The project delivered direct savings of £3,741.94 over 30 weeks, with all savings reinvested into team development.
  • Staff time previously spent on investigating stock discrepancies is now freed for quality improvement projects.
  • The project was shaped by regular feedback from NEMS clinicians and the Trust Pharmacy Team, PCNs, and ICB, ensuring interventions were practical and well-received.
  • No external sponsorship was required.