The Department of Health in Northern Ireland (DHNI) has joined forces with the Department of Agriculture, Environment and Rural Affairs and the Food Standards Agency to launch ‘Changing the Culture: One Health’, their action plan for Northern Ireland (NI) to address antimicrobial resistance (AMR). Their plans include enhancing the role of practice-based pharmacists to review the dose and duration of antimicrobial prescriptions, developing a patient-level prescribing and resistance data source, and giving prescribers feedback on guidance, compliance and prescribing rates.
DHNI warned that antimicrobial resistance development and spread is “one of the most serious threats to health across the world”. Ministers said their five-year action plan for NI, launched yesterday, and prepared in conjunction with a new UK 20-year vision and five-year National Action Plan, encourages the responsible use of antimicrobials, and especially of antibiotics in human medicine, veterinary medicine, in food-producing animals and in pets.
Their framework proposes tackling AMR by reducing infections and unintentional exposure, optimising use of medicines, and investing in innovation, supply and access. Proposals to strengthen AMR stewardship and improve data management include pledges to:
- raise public awareness to encourage self-care and reduce expectations of antibiotics
- in primary care, enhance the role of practice-based pharmacists to review the dose and duration of antimicrobial prescriptions (especially long-term or repeat ones), and work with prescribers to review those that are inappropriate through evidence-based, system-wide interventions
- display antimicrobial consumption, HCAI and AMR rates on a public-facing online dashboard
- work with the Regulation and Quality Improvement Authority (RQIA) to optimise use of inspections to drive improvements in antimicrobial stewardship
- develop a patient-level prescribing and resistance data source, with timely access at point of care to support clinical decision-making, along with access to NICE guidance
- set targets in the annual Commissioning Plan Direction for reducing antibiotic prescribing in the community and in hospitals
- use the development of electronic prescribing to support and drive good antimicrobial stewardship by coding, auditing and providing feedback for surveillance
- use prescribing data to give healthcare providers feedback on guidance, compliance and prescribing rates
- require all infection consultations to record an appropriate diagnostic code, and be subject to audit.
Chief medical officer Dr Michael McBride warned: “As certain antibiotics lose their ability to kill particular strains of microbe, and if we cannot develop new drugs that can beat those bugs, then by the year 2050 we can expect about 10 million deaths per year, worldwide, from drug-resistant infections.
“This is a shocking statistic and that is why we are working together across government, public bodies, the research community and key industry stakeholders to tackle antimicrobial resistance. Antibiotics are used in surgery daily to prevent infection. If the drugs don’t work, routine procedures will no longer be safe. In 2015 it is estimated that 33,000 people died because of AMR in Europe and this figure might be an underestimation. Reducing our use of antibiotics is one of the best ways we can tackle this growing crisis.”
His concerns were echoed by the chief veterinary officer, Robert Huey, who pointed out that AMR has wider implications beyond those of human health. He said: “The emergence and spread of drug-resistant bugs is driven by over-use and inappropriate use of antibiotics in both humans and animals. Antimicrobial resistance to veterinary medicines not only affects human, animal health and welfare, but could also severely affect the agricultural industry as a whole through its potential impact on trade… A ‘One Health’ approach will give us the best chance of progress in contributing to efforts to ensure antibiotics keep working.”