Antimicrobial resistance – Are we losing the battle against bacteria?

By Dr Claire Thompson, RPS Deputy Chief Scientist

Meeting with world health officials in October, Prof Dame Sally Davies, England’s Chief Medical Officer, repeated her warning that if antibiotics lose their effectiveness it would spell the end of modern medicine.

It has been 18 months since Jim O’Neill made his final recommendations on how we can tackle antimicrobial resistance (AMR) globally.  These included the need to:

– Increase public awareness of AMR;
– Reduce the over/inappropriate use of antibiotics;
– Prevent the spread of infections;
– Increase research into new antibiotics by generating a $2bn Global Innovation Fund.

Since then, little has changed within the UK.

At the BioInfect 2017 event Jo Pisani, Pharma & Life Sciences Partner at PwC, gave her state of the nation address on antibiotics and was disappointed to see that little has changed in the pipeline of new antibiotics since the O’Neill reports. “The UK has opportunity to be world leader in antibiotic development, but with so few companies involved in antibiotic R&D, how do we advance the pipelines?” she said.

Source: Antimicrobial resistance: The state of the nation report on UK R&D. PwC. https://www.pwc.co.uk/industries/healthcare/insights/antimicrobial-resistance.html

Where are the new antibiotics?

At the moment, there are less than 100 scientists in the Pharma Industry who are working on new antibiotics. This is mainly due to the lack of reimbursement models for antibiotics.

There have been calls for new models and incentives for developing antibiotics, such as exclusivities on market entry akin to those which are in place for orphan drugs or paediatric medicines, but these are yet to come to fruition.

This means that organisations such as the AMR Centre, charities such as Antibiotics Research, and small companies like Auspherix are leading the charge in developing new antibiotic medicines.
In order to progress the development of new antibiotics, we need to stop focussing on what they are going to cost and start thinking of cost of not having them.

What are we doing to combat AMR?

The key to overcoming AMR is not just about new antibiotics; improving stewardship and raising awareness are imperative. As a profession, these are some of the activities we are involved in.

Public engagement and awareness
With 1.6 million pharmacy visits per day, pharmacists are perfectly positioned to talk with patients and the public about what antimicrobial resistance is, when antibiotics are required, and how to take them. The Test and Treat service at pharmacies is under-utilised. Currently, people aren’t aware of it and don’t know they can talk to their pharmacist.

Antimicrobial Stewardship Programme
In September, the RPS launched the Antimicrobial Stewardship programme  which contains reference, guidelines and support tools for pharmacists.

What impact can we have?

In 2016, Government set a challenge of reducing inappropriate antibiotic prescribing by 50% by 2020. Pharmacists are integral to this. As a profession, we still have some work to do to ensure that the public know that they can talk to pharmacists about health concerns and to get advice on medicines. But the impact we can have as pharmacists (on raising awareness and providing stewardship) and as pharmaceutical scientists (in developing new antibiotics) is enormous.

A tweet from the BioInfect 2017 summarised this perfectly “Great way to cut queues at your GP. Talk to your pharmacist and conserve our antibiotics”.

Contrary to the saying, resistance is not futile – it is rife. But the war on bacteria is not over! Please play your part.

Mother was right!

“Wash your hands when you come in”, “Make sure you wash before dinner”, “Show me your hands” – just some of the echos of my childhood which I’m sure many of you recognise.
Ahead of World Antibiotic Awareness Week  and European Antibiotic Awareness Day  I spent much of my time at the RPS researching, collating and checking resources to support antimicrobial stewardship for the RPS AMS Portal.
I learnt a lot and guess what – our mothers were right!  One of the simplest ways to reduce the use of antimicrobials is hand washing (or hand hygiene as it is referred to in healthcare settings).  Not just to remove visible dirt but to remove bacteria and viruses which could cause infections such as upset stomachs, coughs, colds or pneumonia. Washing your hands properly should take 20 seconds, as long as it takes to sing “Happy Birthday to you” twice.
Simple you think – but wait – the RPS Handwashing essential guide states that 84% of British adults don’t wash their hands for long enough and 65% of people don’t always wash their hands before eating. The infographic below has other figures which make uncomfortable reading.

I mentioned these gruesome figures one evening at home and an unexpected consequence was that my daughter, who teaches a Year 2 class, was interested in using this information at school in some way.  I suggested having a look at the e-bug resource (another resource found during my AMS research) and together with the ‘handwashing and mouldy bread experiment’ (look it up on youtube!) she formulated a lesson plan.  The children loved it – and it became a feature of their end of term assembly.
So, what started as a literature review style research project on antimicrobial stewardship and resistance ended up as a theme for a school assembly.  It illustrates that antimicrobial stewardship belongs to us all – organisations, health professionals and all ages of members of the public.  Now, during World Antibiotic Awareness Week, take some time to have a look at the AMS Portal.  This is essentially a signposting resource linking to antimicrobial stewardship resources under six key categories: strategy, policy and guidance; clinical and technical guidance, initiatives and campaigns, training and educations resources, journals; and organisations.  The AMS Portal focuses on GB resources for pharmacists and pharmacy teams although we recognise the need to signpost to worldwide information and resources from outside GB are also included.
Have a browse – you might even find yourself influencing another school lesson or even humming ‘Happy Birthday to you, Happy Birthday to you………………….’!

Integrative medicine approach to treating cancer patients

By Louisa Davies, Senior Clinical Oncology Pharmacist at University College of London Hospital

I love my job! I’ve been a qualified clinical pharmacist for 12 years and am very fortunate to work at the wonderful Macmillan Cancer Centre at University College Hospital in London as a specialist oncology pharmacist. I find it immensely rewarding as every day is an opportunity to support someone along their cancer journey.

I have a personal interest in wellness and the growing use of supplements for health and over the past few years I have seen more and more patients adopting an integrative approach to their cancer care. At UCLH we recorded that around 35% of patients we saw in clinic were taking or wanted to start taking supplements to improve their side effects or boost their immunity whilst on anti cancer therapy. Read more Integrative medicine approach to treating cancer patients

Revalidation for pharmacy professionals

By Nigel Clarke, Chair, General Pharmaceutical Council

Over the past three years, the General Pharmaceutical Council has done a great deal of work on professionalism – how to ensure that the standards we set support professionalism; and, as important, how to assure patients and the public that registrants are upholding these standards and keeping up with their knowledge and skills, and with new developments in the professions.

This work has coincided with a period of change in the pharmacy sector – changes in the healthcare landscape, the role of pharmacy and the expectations placed on pharmacy professionals; and changes in the core knowledge and skills required to deliver safe, effective, person-centred care.

As a part of this effort, we have engaged with members of the profession, with patients, and with other healthcare professionals to hear their views on professionalism, and, in particular, how they can be assured that pharmacy professionals have up-to-date knowledge and up-to-date understanding of issues affecting healthcare, pharmacy and the way care is delivered.    Based on their feedback, and underpinned by the findings in the pilot programme we undertook last year to test our approach, we have proposed to introduce revalidation for pharmacy professionals.   That proposal is the subject of our recent consultation on revalidation.

.    Our approach aims to do away with exhaustive record keeping and ‘tick-box’ exercises – which many registrants felt were no longer fit for purpose, and the public find hard to equate with professional development – and introduce a more thoughtful approach to ensuring that professional development is not just documented, but embedded in practice.    Our proposal incorporates peer discussion, and reflection on the GPhC’s standards for pharmacy professionals and registrants’ individual practice to provide meaningful reassurance to the public that real learning and improvement are taking place.

Among the key changes we are proposing with revalidation are: reducing the number of required CPD records from nine to four; conducting a peer discussion with a colleague or someone who understands your work; and writing a reflective account detailing how you are meeting one or more of the standards for pharmacy professionals. We are also proposing that, rather than ‘calling’ records periodically for review, the GPhC would require them to be submitted annually; with a small sample (about 2.5 per cent) randomly selected for review.

This approach is designed to underpin the professional approach of pharmacists and pharmacy technicians, and reflects too the way in which other professions are now engaging in revalidation. It is based upon the view that a consistent pursuit of improvement in practice is the best way to ensure ongoing high standards within pharmacy, and with it greater safety for the public and patients. During our initial pilot, this approach has been widely supported by the professionals who took part.

I would encourage all pharmacy professionals to weigh in with their views on our proposal.  Have there been any points or considerations that we’ve missed?  Are there any changes that we need to make?  Are there emphases that we’ve not properly understood?

And while it is likely that the final plan will not come into effect until 2020, pharmacy professionals can and should begin to prepare themselves now for the inevitable changes that will come from this effort.

As a start, I would encourage all registrants to read the new standards for pharmacy professionals, which sit at the heart of the proposals for revalidation.   Understanding the standards and thinking how they can and should be embedded in practice will be an important best practice to embrace in preparation for revalidation when it comes into effect.

Registrants can also begin to talk about their practice with their colleagues and peers.  The idea of a ‘peer discussion’ may feel daunting at first, but many of our pilot volunteers realised they were already having these kinds of conversations, albeit informally, and that the candid insights and advice they received helped to improve their practice.    So, I would urge you to reach out to colleagues and peers, or perhaps tap into the resources available to pharmacy professionals, such as the RPS Faculty, and start these conversations.

Revalidation will be an important step for the pharmacy sector and for the GPhC as its regulator.   Aside from assuring the public that pharmacy professionals are maintaining high standards of practice and improvement, our revalidation proposal represents our commitment to regulating in a way that is flexible, that supports professionalism and that is fit for today’s pharmacy and healthcare environment.  I look forward to sharing some of the feedback we hear from our consultation when I speak at the RPS conference in September.   I hope to see you there.

Better information on patient information leaflets

By Professor D.K Theo Raynor, Professor of Pharmacy Practice, University of Leeds
A new report published by the Academy of Medical Sciences says that medicine information leaflets are too scary with too much focus on the potential side-effects of medicines and not enough on their benefits. The report calls for them to be rewritten to give a more balanced view.

This is a comprehensive and thoughtful report looking at enhancing the use of scientific evidence to judge the potential benefits and harms of medicines. Of particular interests to those working in Pharmacy are the recommendations relating to patient information leaflets (PILs) – found in the pack of every medicine dispensed in the UK. The key recommendations relating to ‘Improving the content of PILs’ are:

• All parties to improve the comprehension and readability of patient information leaflets in line with the current legislation.
• This should ensure a balanced appraisal of the medicine’s potential benefits and risks is made accessible in these documents.

These recommendations echo the recent report for the European Commission on the ‘shortcomings’ of PILs produced by the Universities of Utrecht and Leeds.(1) Not mentioned in the Academy’s report is that for more than 10 years, manufacturers have had to ‘user test’ their PILs with lay people – so they are already ‘revised in consultation with patients and carers’. Despite this testing, further improvements are needed, with a more rigorous application of the user testing process, ensuring that it is iterative – with repeated testing and improvement until the required level of readability is reached. Read more Better information on patient information leaflets

A medicine review is about stopping medicine as much as it is about prescribing

By Dr Mahendra Patel, English Pharmacy Board Member

The RPS has published a joint report with RCGP on polypharmacy “The challenge of polypharmacy: from rhetoric to reality”. The report is a practical guide for the delivery of improved care and increased safety of our patients.

Multimorbidity is perceived as an inevitable consequence of an ageing population, with increasing ‘polypharmacy’ necessary to prevent complications arising from long term conditions.  Patient conditions are often treated individually and they are prescribed medicines accordingly. However, medicines that were once prescribed may no longer be necessary as well as in some instances new medicines may not be required. Pharmacists have a key role in supporting patients to get the most out of their medicines and ensure that they are only taking the medicines that they actually need. Read more A medicine review is about stopping medicine as much as it is about prescribing

Research is everyone’s business

By Sonia Garner, Research Support Manager, RPS

Research is a young person’s game, an academic career pathway, something that doesn’t apply to me – to me, a middle-aged pharmacy professional with a background in community pharmacy support.  So it was with some trepidation that I found myself booked into the NHS Research and Development (R&D) Forum Conference in Manchester, May 15-16 2017: not only booked in as a delegate but with a poster presentation and an RPS stand to man.  So how did this come about?

Ten months ago I was appointed to cover a maternity leave position at the Royal Pharmaceutical Society (RPS) as a Research Support Manager with responsibility for the Research Ready accreditation scheme for community pharmacy. Read more Research is everyone’s business

What is the concern about Atrial Fibrillation?

Sharron

By Sharon Gordon, Pharmacist Consultant Anticoagulation & Faculty Fellow of The Royal Pharmaceutical Society

Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia affecting 1-2% of the UK population. AF is affecting approximately 10% of the population over 75 years old and 18% of those over 85 years old. It is a predominant cause of stroke and a serious concern in in our aging population. Clinical outcomes in terms of increased disability are considerably worse for AF-associated stroke and mortality from stroke is doubled in patients with AF. Read more What is the concern about Atrial Fibrillation?

How to get an NIHR research fellowship

Mandy WanBy Mandy Wan, Lead Paediatric Clinical Trials Pharmacist at Guy’s and St Thomas’ NHS Foundation Trust and HEE/ NIHR Doctoral Research Fellow

I was delighted to hear just before Christmas that I was successful with an NIHR fellowship application and want to encourage more pharmacists to apply for funding and to lead research.

I have been a paediatric clinical trials pharmacist for most of the past 10 years, so am lucky to already be closely engaged in research work and have an understanding of how research can really impact day to day practice.
I applied for NIHR funding 2 years ago but I wasn’t successful. This time, I decided to apply again with a different topic. My research question came from a common query that kept coming through to the pharmacy department; what dose of Vitamin D is appropriate in children? Read more How to get an NIHR research fellowship

The rise of antibiotic resistant bacteria

Dr Jacqueline Sneddon

Dr Jacqueline Sneddon MRPharmS FFRPS
Project Lead for Scottish Antimicrobial Prescribing Group

Consider this scenario. Your younger child has been awake all night, crying with earache. They’re upset and tired, and so are you. Your older child had a flu bug last week, and you have already taken three days off work to look after them. You’ll take the little one to the doctor in the morning and get antibiotics to clear it up. You’ll probably have to pester the GP for them, but you’ll do it so your child feels better quickly and you can go back to work sooner.

In addition to being really worried about our little ones, as parents, we also have to cope with the guilt of being away from work for too long, and for many parents this is unpaid leave.
The sight of a poorly child is an upsetting one. The hope that antibiotics will reduce the time our children suffer with pain, sometimes means that exhausted and worried parents demand a prescription for antibiotics, even though the GP didn’t really think they were necessary. Read more The rise of antibiotic resistant bacteria