Your mission: To use antimicrobials wisely – Kaitiaki Nursing New Zealand

November 18-24 is World Antimicrobial Resistance Awareness Week (WAAW)

World AMR Awareness Week aims to improve awareness and understanding of antimicrobial resistance (AMR). The New Zealand Antimicrobial Stewardship and Infection Pharmacist Expert Group (NAMSIPEG) has provided the following information to support this initiative.

About AMR

AMR is one of the top 10 global public health threats, causing over 1.3 million deaths each year. The biggest driver of AMR is use of antimicrobials, including overuse and misuse. AMR compromises routine and complex medical care, such as surgery and cancer treatment, where antimicrobials are needed to manage infection.

Learn more about AMR from the Ministry of Health Manatū Hauora , the World Heath Organization, the Australian Government and the European Centre for Disease Prevention and Control.

About WAAW 2023

The major cause of antimicrobial resistance is overuse and misuse of antimicrobial drugs. Photo: Adobe Stock

This year’s global theme is Preventing AMR together and our national theme is Indications in antimicrobial prescriptions. This means being specific about what the prescription is for, for example, write “cystitis” or “pyelonephritis” rather than “UTI” or “infection”.

Eighteen organisations have joined together in Aotearoa this year to promote documenting the rationale for antimicrobial use in the prescription. This action can help improve patient care and conserve antimicrobial effectiveness (see poster below).

A range of free resources (including posters, screen savers and this information as a printable bulletin) are available on the New Zealand Pharmaceutical Society website.

Prescribers need to ensure they use a precise indication on an antimicrobial prescription. Photo: Adobe Stock

What can health professionals do to help slow AMR?

Use antimicrobials wisely by:

only using them if the benefits likely outweigh the harms
following relevant local guidelines and having a low threshold for seeking advice
thinking the “4Rs” – right agent, right route, right dose and right duration
challenging the veracity of penicillin allergies – see 2021 WAAW resources
documenting the indication and course duration (ie, review or stop date) in the prescription.

Prevent infections and spread of resistant microbes by:

washing hands regularly
following relevant infection control guidelines
ensuring safe food handling
keeping vaccinations up to date
encouraging safer sex practices
avoiding unnecessary use of invasive devices such as IV lines, and removing them promptly when no longer required.

National antimicrobial guidelines 2024

Aotearoa has much duplication in antimicrobial guideline development at district, regional and national levels. This creates inconsistencies and is inefficient.

A team of clinicians is now working collaboratively across the motu to harmonise the existing guidelines into a national standard for antimicrobial prescribing. The guidelines will be freely available in both mobile and desktop versions and will be launched in November 2024.

Getting involved

The national antimicrobial guideline development is part of a suite of projects aimed at promoting effective, safe and equitable antimicrobial use. An introductory letter has been widely distributed. If you are keen to contribute, or are interested in hearing about progress, contact [email protected]

He Ako Hiringa tools to help slow AMR

EPiC dashboard

EPiC is a data analytics tool that enables clinicians to compare their own prescribing with prescribing for all patients in their practice and with patients nationally, using age, gender, ethnicity and socioeconomic deprivation quintile filters.

Community dispensing of antibacterials accounts for around 95 per cent of human antibacterial consumption in Aotearoa1 so small changes to practices in primary care can have significant effects on addressing antimicrobial resistance in the community.

The EPiC antibiotics dashboard helps clinicians to review their prescribing of antibiotics and consider areas where they might implement change. Data are included for urinary tract infection, seasonal variation, use of amoxicillin + clavulanic acid and use of topical antibiotics.

An example of the antibiotics prescribing data available on the EPiC dashboard.

The CQI Toolkit

The continuous quality improvement toolkit consists of an activity guide, a data collection form and an information sheet. The resources guide you through identifying an area for improvement, collecting baseline data from EPiC antibiotics, implementing a change, and collecting subsequent data to determine if the change has been beneficial.

The toolkit uses antibiotic prescribing throughout the example templates, making it an ideal aid for improving antimicrobial stewardship and reducing AMR. The toolkit is endorsed by the RNZCGP to help medical practices meet various requirements of the Foundation Standard and the Cornerstone CQI and Equity modules.

Acknowledgements

WAAW content was obtained, with permission, from the November 2023 Antimicrobial Stewardship bulletin 041, written by Te Whatu Ora Waitaha Canterbury Hospital Antimicrobial Stewardship Committee in conjunction with NAMSIPEG.

Reference

Duffy, E., Ritchie, S., Metcalfe, S., van Bakel, B., & Thomas, M. G. (2018). Antibacterials dispensed in the community comprise 85%-95% of total human antibacterial consumption. Journal of Clinical Pharmacy and Therapeutics, 43(1), 59-64.

Antimicrobial Resistance Collaborators. (2022). Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet, 399(10325), 629-655.
World Antimicrobial Awareness Week (WAAW) will now be World AMR Awareness Week
Kotahitanga – Uniting Aotearoa against infectious disease and antimicrobial resistance

Uncut – news briefs

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18 Nov	Potential travel disruption expected with Tuesday’s national Hīkoi Health New Zealand \| Te Whatu Ora urges those with an appointment scheduled at Wellington Regional Hospital on Tuesday morning or early afternoon, to please allow extra time to get to appointments.
15 Nov	ICN’s calls on G20 leaders to address international health worker migration crisis Ahead of the G20 Leaders Summit in Rio de Janeiro next week, the International Council of Nurses (ICN) welcomes the Declarations recently adopted by the G20 Health Working Group and health ministers.
13 Nov	Measles case confirmed in Tāmaki Makaurau Health New Zealand \| Te Whatu Ora has confirmed today that a new case of measles has been identified on Waiheke Island in Auckland. The case and their household are being supported by the National Public Health Service (NPHS), with those most at risk now in quarantine to help reduce the chance of further spread.
5 Nov	Safety fears ahead of changes to mental health 111 calls Mental Health Nurses have serious concerns about the safety of their patients, the public, their colleagues and themselves when police changes to emergency 111 calls come into effect on Monday, New Zealand Nurses Organisation (NZNO) Tōpūtanga Tapuhi Kaitiaki o Aotearoa says.
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10 Oct	Call to immunise now as New Zealand at high risk of whooping cough outbreak Pregnant people, babies, children and others at high risk from whooping cough are urged to get vaccinated as soon as possible, as Aotearoa New Zealand stands at high risk of an outbreak.
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2 Oct	Orion Health and Streamliners form strategic partnership Orion Health, a global leader in digital health solutions, has announced a strategic partnership with Streamliners, creators of HealthPathways which provides an online manual used to assist with clinical assessments.
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26 Sept	Govt not addressing health workforce crisis The National Government is hiding the gaps in the health workforce from New Zealanders, by not producing a full workforce plan nearly a year into their tenure.
25 Sept	New programme offers step up for jobseekers seeking a career in health and wellbeing Local jobseekers have an exciting new opportunity to begin a career in Health following the launch of a new community-based kaiāwhina programme in the Hutt Valley.
23 Sept	Ministers oblivious to cuts’ effect on families The National Government is oblivious to the impact cuts to services will have on New Zealanders who are doing the hard yards caring for mentally ill family members.
19 Sept	Wānaka community to benefit from new overnight health service Health Minister Dr Shane Reti says an Overnight Acute Care Service opening in October will provide people in Wānaka and the surrounding area with the assurance of quality overnight care closer to home.
17 Sept	Dr Le Heron takes title of 2024 Alzheimers NZ Fellow Distinguished neurologist and cognitive neuroscientist, Dr Campbell Le Heron, has been made the 2024 Alzheimers NZ Fellow for his work researching and managing cognitive disorders.
11 Sept	Aged care will be worse off if redesign rushed New Zealanders needing aged care support and the people who care for them will be worse off if the Government pushes through a flawed and rushed redesign of dementia and aged care.
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10 Sept	ICN launches new position statement and discussion paper setting out a revolution in the delivery of Primary Health Care The International Council of Nurses (ICN) is launching its new position statement and a discussion paper on Primary Health Care (PHC) at its Nurse Practitioner/Advanced Practice Nursing Network (NP/APN Network) Conference in Aberdeen, Scotland.
9 Sept	First cancer medicine decision following Pharmac funding boost Pharmac has decided to widen access to two medicines for several types of cancer. Pembrolizumab (branded as Keytruda) will be funded from 1 October 2024 for eligible people with advanced triple-negative breast cancer, head and neck cancer, colorectal cancer, bladder cancer, and Hodgkin lymphoma. Nivolumab (branded as Opdivo) will be funded from 1 November for eligible people with kidney cancer.
6 Sept	Health agencies working with Police on rebalancing roles for mental health responses Health New Zealand \| Te Whatu Ora and the Ministry of Health - Manatū Hauora are working with Police to change some of the ways agencies respond to mental health. The change will see an increased health-led response, supporting Police to focus on core Policing.
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