In 2012, the Chief Medical Officer for England published the first ever 5 Year Antimicrobial Resistance Strategy. A UK High Level Steering Group followed, which acts as the system steward, providing challenge and ensuring all recommendations are enacted.
Public Health England is responsible for four of the recommendations (including education and training; infection prevention and control) and this is where we, as nurses, come in.
Nurses and midwives are a vital resource for tackling this huge public health challenge for the 21st century. We have the knowledge and skills to take the lead.
But what needs to happen and what can nurses within and beyond PHE do?
With over 670,000 nurses and midwives registered with the NMC across the UK, we are the largest professional group. Given the right information, resources and system leadership, we will be empowered to rise to the challenge of reducing antimicrobial resistance. Quite a powerful thought isn’t it?
Because targeting prescribing habits alone will not reduce antimicrobial resistance. This problem requires system-wide acknowledgement and ultimately leadership, stewardship, a multidisciplinary and multi-interventional approach, of which nurses contribute every day in their professional practice. Some of these areas are included below:
- Infection prevention and control
- Medicines management
- Harnessing technology
- Improving adherence to policy through behaviour change
- Education and empowerment of patients, staff, public and carers
- Nurse prescribing
- Immunisation and vaccination programmes
- Promoting health and well-being and immunity
- Patient/user/public expectation and relationships
- Care pathways
The stark reality is, we simply don’t have a new generation of antibiotics in the pipeline and some organisms are becoming resistant. If we don’t take this seriously now – all of us - antibiotic resistance will have a lasting impact on our global population, both today and in the future. It’s a global problem, a burning platform (according to the CMO), which will have an effect on every human being if we do not strive to reduce and control it now.
Infections and infectious diseases will become more difficult and expensive to treat. This in turn will contribute to the spread of infection and increase the duration and severity of illness. It will have an impact on routine surgery, limit the use of antibiotics which may cause milder side effects and require an increase in infection prevention and control measures. This will include isolation, which will have a negative impact for all sorts of reasons, let alone social isolation and fear for the person involved.
As passionately expressed by Dr Mitchell Schwaber, Head of Israel’s National Centre for Infection Control at this week’s annual PHE conference, we need to call it like it is! Initiatives rightly target prescribing habits and prudent use of antibiotics but we must also add our nursing leadership to ensure these strategies make the greatest impact in improving patient and population level outcomes.
We can lead from the front and maximise the nursing contribution to this challenge.
Nurses reach out to all members of society, not just the sick, so who is better placed to contribute both reactively and pro-actively? Nurses are the main professional workforce that encompasses all domains of health and care, across the life course and from ward to Board.
The potential contribution that nurses will make to the 5 year strategy is phenomenal.
Within the profession there are numerous specialities, networks, forums and other groups, some formal such as the Royal College of Nursing, Infection Prevention Society, Hospital Infection Society, and other informal groups such as those via social media (@WeNurses). By tapping into these established expert networks and empowering nurses, information can be communicated widely both from the top down and bottom up.
The value and visibility of nurses being on the front line cannot be underestimated as they know what will work and what does not in their particular field of practice. Front line staff are key players in influencing patient and colleagues’ behaviour. They lead the implementation of new policies, promoting health and well-being and self-care as well as taking on the privileged role of patient/service user advocate.
As part of the multi-disciplinary team, nurses are in an ideal position to spread the word, become Antibiotic Guardians, and contribute to antimicrobial stewardship.
How do we do this? By familiarising ourselves with policies and national guidance and being vigilant when administering or advising on medicines and antibiotics, notifying certain infections on suspicion, administering medication on time and avoiding missing doses.
We must check prescription charts for allergies, stop/start dates, check microbiology culture results, develop clear individual care plans and documentation records and remove unnecessary devices.
We should also inform and educate others, especially patients/service users on antimicrobial resistance and carry out evidence based practice to promote infection prevention and control and raise awareness that antibiotics do not work on all infections.
Antimicrobial resistance and infection prevention and control is everybody’s business not just the domain of prescribers. Nurses can and will rise to the challenge and embrace this initiative under the framework Personalised Care, Population Health. And we will lead with you, from the front!
This week PHE launched the Antibiotic Guardian campaign – we’re calling on health professionals and the public to help save some of our most precious medicines.