Reducing inappropriate antibiotic prescribing

by Pippa Clark and Lauren Marshall

After Dr Palacin’s surgery received a letter from the Department of Health & Social Care advising that their antibiotic prescribing was too high, staff decided to tackle the issue using Quality Improvement (QI) methods.

Identifying the problem

“Focussing on all inappropriate antibiotics would be a huge project, and one that we would like to tackle, but we decided to start focussing on antibiotics prescribed for Urinary Tract Infections (UTIs).

“To help identify why prescriptions were so high we created a report on SystmOne (a secure centralised computer system used by healthcare professionals), which we operated weekly to organise and analyse results. The data for prescribing antibiotics for UTIs was a bit erratic due to different seasons, holidays and repeat prescriptions. So, we decided to focus on staff prescribing and separated the data for each doctor, working with them to detail what the reasons were behind the prescription.

“As the weekly monitoring results were being studied, we realised that a lot of reception staff were prescribing antibiotics using a repeat prescription template.”

The process

“We developed a driver diagram to understand the factors that might impact on our ability to accomplish our objective. From this, we developed different ideas to implement change and started trying to achieve our aim.

“As a result, we put in place processes, guides and incentives to help staff to understand why antibiotics should not be prescribed by anyone except a GP. This led to an immediate decrease in antibiotic prescribing for our practice.

“Additional changes that we made included:

• Introducing dipstick and lab testing
• Providing information on most effective antibiotics for UTIs
• Sharing information with patients on different ways of treating UTIs including things they can do at home
• Sharing information with patients and staff about antibiotics becoming ineffective with excessive and unnecessary use and how to prevent this from happening.”

The project outcome

“We have seen a huge improvement as a result of our work and have been praised by Medicines Management and the CCG for a 10% decrease in our antibiotic prescribing throughout the year. We plan to use our knowledge from the QI Collaborative programme to build new QI projects to improve other areas within our practice.”

Find out more about the South East Essex Quality Improvement collaborative here.