Milton Keynes Primary Care Trust

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Milton Keynes Primary Care Trust

• Jenny Brooks Deputy DIPC
• Naomi Fleming Antibiotic Pharmacist

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Improving IPC Practices Within Long Term Care
Homes

• 6 homes taking part in the project
• Nursing, residential, EMI
• Privately owned and Council run
• Different sizes and locations across MK

• Project Nurse appointed full time
• Highly visible
• Develop relationships
• Understand local issues
• Complete baseline audits
• Facilitate action plan development
• Plan/deliver relevant training

Aiming for zero MRSA bacteraemia originating
from these homes
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Baseline Audits

• Hand Hygiene
• Enteral Feeding
• Urinary Catheter Care/Management
• Standard Precautions
• Utilising a variety of methods and based around
  Essential Steps toolkit

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Overall Findings

• Lack of accessible policies
• Lack of understanding of role of HPU
• Lack of education/training
• Lack of facilities/resources
• Conflict between homely environment and safe
  practice
• Reluctance to share information between homes
• Inconsistent interpretation of CSCI standards
• Project plan reviewed, expanded overall goals!

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Key Concerns

• Management of long term urinary catheters
• Lack of training/education
• Poor communication on discharge from acute
  settings
• Lack of local evidence based policies
• Record keeping not joined up
• Lack of understanding of risks
• Locally, MRSA bacteraemia originate from this
  client group

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Our Actions To date

• Shared our findings with care home managers,
  local hospital, social care teams, district
  nurses etc
• Provided education standard precautions, hand
  hygiene and importance of risk assessment
• Provided highly visual posters for display in all
  project homes
• Sustained support and surveillance
• Secured funding for a substantive post Practice
  Development Nurse
• Study day for all care homes across MK good
  response

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Future Plans- The project and beyond!

• Development of IPC forum for carers/clinicians
  from all MK care homes good response
• Continue with education programme train the
  trainers
• Develop stronger links between care homes and
  district nursing teams
• Ensure good transfer of care information to and
  from acute settings
• Repeat audits
• Introduction of Essential Steps toolkit
• Follow up of at risk residents
• Review local policies aimed at supporting best
  practice
• Roll out across all care homes!

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Putting the lid on Antibiotic Prescribing
Cefalexin Ciprofloxacin Co-Amoxiclav
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AIM To Reduce the MK PCT Antibiotic Prescribing
Rate to that of National

• Prescribers
• Medical groups
• Public groups
• Patient groups
• Patient Information

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Prescribers

• QOF target
• Highest 10 prescribing GP practices
• Link with c.diff. figures
• Compliance with AB formulary
• Practice meetings non-prescription pads,
  laminated copy of policy, position within PCT
• Surveys
• Address patient expectations in conjunction with
  written information.
• Address GPs perceptions of high AB users
• Poster displays

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Antibiotic Prescribing Data MK PCT vs. National
and Year on Year.
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Major Survey Findings to Date

• Patients highest users of antibiotics white
  16-60years female, then male.
• Reasons behind use Validation of illness, cope
  better, get better quicker.
• Patients still demanding antibiotics.
• GPs perception of demand.
• Increased patient awareness of resistance, but
  lack of relevance to them.
• Lack of c.diff. knowledge.
• Misconception of cost cutting.

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Medical Groups

• Community pharmacists and staff
• Specific MCA training events.
• Antibiotic resistance
• Advice on symptoms
• C.diff. warning signs
• Hygiene issues
• Clinical audit, preliminary results
• Increased use of written information
• Increased patient awareness of c.diff. symptoms
• CPD and pharmacist awareness
• Ongoing use of materials eg. Leaflets, posters,
  labels as a result of audit.
• Tie in with AB pharmacist at hospital

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Public Events

• Diabetes UK
• Falls awareness
• Joint PPI forum
• Age Concern
• Bumps and Babes
• Media

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Future Work Specific Patient Groups that are
High Users of Antibiotics

• Children
• COPD patients
• Elderly patients with UTIs
• Ethnic minorities

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Successes

• Links with other healthcare professionals
• Patient education materials
• Training events for pharmacy staff and healthcare
  professionals.
• Just a quick note to say how much my staff
  enjoyed the "new" format of the meeting. Not only
  the format - they are now scrubbing their hands
  to within an inch of their lives! It sounded like
  a good meeting - they haven't stopped talking
  about it. This will certainly encourage them to
  attend more of these events.

Just want to say how very worth while the
presentation was yesterday given by Naomi.  The
presentation itself was excellently presented and
very interesting. Such a valuable topic at the
moment - thank goodness they brought people like
Naomi into these posts, who will make a big
difference.
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Challenges

• Organizing an effective feedback mechanism for
  the project results to the GPs.
• Addressing surgery expectations around IPC issues
  outside of project remit.
• Secure local funding for antibiotic pharmacist
  beyond the life of the project

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Thank you for your attention