1. Monitoring impact of your practice policy - please view the clinical audit tools below:
There is considerable evidence in human health that auditing antimicrobial use can be a powerful tool to changing prescribing practices. If the highest priority critically important antibiotics are used sparingly then we can preserve their effectiveness for the future.
BEVA has created a flexible framework allowing veterinary surgeons to undertake effective clinical audit without significantly impacting on working practices. This will help members comply with their obligations under the RCVS practice standards scheme
2. Monitoring the impact of your policy on emergence of antimicrobial resistance
Regular review of emerging antimicrobial resistance is as important as the establishment of your initial practice policy. It will enable you to monitor the effectiveness of your practice protocol in reducing the emergence of resistance, while making it respond to changes in bacterial sensitivity in your practice.
The practice should establish a protocol for monitoring of emerging resistance. The guide below is designed to give a simple mechanism, but can be adapted as needed to your individual needs. Ideally bacterial culture and sensitivity will be undertaken prior to any change in antimicrobials, in a prospective manner, however the analysis of any culture and sensitivity can be used in an opportunistic manner.
The purpose of this process is to record the development of resistance that should impact on your prescribing policy. An example template document for recording and reviewing the emergence of antimicrobials is shown below
3. Monitor use of critically important antimicrobials in your practice
Decisions regarding antimicrobial selection are often based upon previous experience of a disease. In order to promote change of behaviour BEVA suggest that practices require staff to record the reasons why critically important antimicrobials are used. These antibiotics include
- The macrolides (eg erythromycin)
- The fluoroquinolones (eg enrofloxacin)
- The 3rd and 4th generation cephalosporins (ceftiofur and cefquinome)
Experience from practices that have developed this policy have seen a 90% reduction in the use of these agents.