Intended for healthcare professionals


A prescription for better prescribing

BMJ 2006; 333 doi: (Published 31 August 2006) Cite this as: BMJ 2006;333:459

Positive experience with a multidisciplinary UK initiative to improve antimicrobial prescribing

We would like to fully endorse the proposals put forward by Aronson
et al and add to them by proposing that any prescription to improve
prescribing needs to be undertaken at a UK level and include all the
prescribing professions.

To support this approach as an achievable aim, we would like to
highlight our recent positive experience with regard to professional
education towards antimicrobial prescribing.

Antimicrobial resistance is now regarded as a major public health
problem. The Department of Health Specialist Advisory Committee on
Antimicrobial Resistance (SACAR) have identified many issues to do with
the management of antimicrobials that could be addressed through
appropriate training in antimicrobial prescribing, policy and practice.

Health Professionals regularly have to make complex decisions about
antimicrobial use, balancing the benefits of effective treatment against
the risks to individual patients and public health from overuse of
antimicrobials. Not surprisingly they are confused by conflicting messages
about how resistance should influence their prescribing and how their
prescribing influences resistance. Clearly prudent antimicrobial
prescribing is an important issue in its own right but it is also a core
topic that links prescribing quality improvement to patient safety and
continuing professional development.

A number of strategies have been used to encourage prudent
antimicrobial stewardship including formularies, prior approval,
guidelines, prescriber education and post-prescribing microbiological
evaluation. Such strategies are however difficult to implement and despite
recent initiatives, there is robust evidence that much antimicrobial usage
is still inappropriate.

Key to encouraging antimicrobial stewardship is prescriber education,
both at the undergraduate and postgraduate level. Due to ongoing changes
in legislation, an increased number and range of health professionals can
now supply antimicrobials through a variety of mechanisms. It is therefore
essential that professional education initiatives to encourage prudent
antimicrobial stewardship are coherent and address the needs of the
individual professions.

This is an achievable aim and our experience has shown that the
representative bodies are willing to engage. In June 2006, SACAR
( launched an antimicrobial
education initiative that was attended by bodies representing all four
prescribing professions, across the UK. The Initiative aims to identify
existing arrangements for prescriber education and define best prescribing
practices with respect to antimicrobials. The practical approach we have
developed to achieve our aims is the development of learning outcomes,
which are statements that indicate what a student should know, understand
and be able to do by the end of an educational programme.1 This will
provide a robust and transparent framework for curriculum development at
all stages. The learning outcomes could be translated into competencies by
the appropriate bodies. The initiative will also be a platform for the
development of training resources that will be made publicly available
through a website: PAUSE (Prudent Antibiotic Use) that is being developed
and maintained by the British Society for Antimicrobial Chemotherapy

Peter Davey (Chair of SACAR Professional Education Committee and
President of BSAC)

Roger Finch (Vice Chair, SACAR)

Sarah Garner (Pharmacist Lead, SACAR)

Richard Wise (Chair, SACAR)

1 L. A. Paterson Davenport, P. G. Davey, and J. S. Ker. An outcome-
based approach for teaching prudent antimicrobial prescribing to
undergraduate medical students: report of a Working Party of the British
Society for Antimicrobial Chemotherapy. J.Antimicrob.Chemother. 56:196-
203, 2005.

Competing interests:
None declared

Competing interests: No competing interests

13 September 2006
Sarah E Garner
SACAR Pharmacist Lead
Peter Davey (Chair SACAR Professional Education Committee /President BSAC), Roger Finch (Vice Chair SACAR), Richard Wise (Chair SACAR)
Expert Advice Support Office, Health Protection Agency NW9 5DF.