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Appendices

07

Accessible Word document

You can download an accessible Word document of the full framework: Containing and controlling antimicrobial resistance: A knowledge and skills framework for health and social care in Scotland | Turas | Learn

How the framework was developed

The development of the framework was supported by a wide range of stakeholder and clinical experts from different care settings. The Delphi study carried out as part of the work was supported by the Safeguarding Health through Infection Prevention (SHIP) research group at Glasgow Caledonian University.

The key steps in the framework development process were:

  • A Short Life Working Group (SLWG) with stakeholders from health and social care and higher education was established to oversee the creation of the framework and provide clinical governance and subject matter expertise.
  • A literature search and an internet search were undertaken to gather evidence from existing AMR/AMS frameworks. These identified seven relevant AMR/AMS frameworks and two additional papers.
  • The key reference documents were used to map domains and topics and create a list of draft domains, competencies and statements. These were then developed into a questionnaire for a Delphi study.
  • Participants were recruited from SAPG, SMVF, SANG, ASAP and the AMS Education Framework Short Life Working Group. These groups were selected as, in order to meet the recommendations of a Delphi study, participants need to be individuals reflecting expertise, in this case, in the education and practice of antimicrobial prescribing and stewardship.
  • An online Delphi study was conducted with two survey rounds to reach consensus on the statements to be included. Gatekeepers were used to distribute the participant information sheet and survey, and consent was implied on completion of the questionnaire.
  • A mapping exercise was carried out with the same expert participants to align the statements to indicative staff groups.
  • The draft framework was edited by the SLWG before it was distributed for wider consultation.
  • The draft framework underwent a 4-week consultation period which enabled colleagues from many disciplines across health and social care to comment on the draft framework before final publication.

Review and governance

An evaluation and update of the framework is planned after the first year of publication.

The framework will be maintained and updated by NHS Education for Scotland and the Scottish Antimicrobial Prescribing Group.

Short Life Working Group

The following organisations, teams and professional groups were represented in the Short Life Working Group:

  • Association of Scottish Antimicrobial Pharmacists (ASAP)
  • Glasgow Caledonian University
  • Healthcare Improvement Scotland
  • NHS Ayrshire & Arran
  • NHS Dumfries & Galloway
  • NHS Education for Scotland – Dental Directorate
  • NHS Education for Scotland – Nursing. Midwifery and Allied Health Professions Directorate (IPC Education Team)
  • NHS Education for Scotland – Pharmacy Directorate
  • NHS Greater Glasgow & Clyde
  • NHS Golden Jubilee National Hospital
  • NHS Lothian
  • NHS National Services Scotland
  • NHS Tayside
  • Scottish Antimicrobial Nurses Group (SANG)
  • Scottish Antimicrobial Prescribing Group (SAPG)
  • Scottish Care
  • Scottish Government – Antimicrobial Resistance Team
  • Scottish Microbiology and Virology Forum (SMVF)
  • Trust Housing Association
  • University of Dundee.

Statements of support

Scottish Antimicrobial Nurses Group

The importance of antimicrobial stewardship in all health and social care settings cannot be overstated. This framework is designed to promote the appropriate use of antimicrobials, aiming to optimise patient outcomes while minimising the risk of antimicrobial resistance. As health and care providers who often have the most direct interaction with those in care, nurses and midwives play a pivotal role in the successful application of AMS strategies and the Scottish Antimicrobial Nursing Group (SANG) welcome the inclusion of nurses in this framework.

Nurses and midwives are uniquely positioned to influence the prescribing and administration of antimicrobials. They frequently assess patients' conditions, monitor therapeutic effects, and provide critical patient education. By adhering to AMS principles, nurses and midwives can help ensure that antimicrobials are prescribed only when necessary, that patients receive the correct drug, at the right dose, and for the appropriate duration. In many cases, nurses and midwives are instrumental in identifying early signs of adverse reactions or the failure of antimicrobial therapies, which can directly influence treatment decisions.

Supporting nurses and midwives with appropriate training, resources, and involvement in AMS initiatives will help ensure better health outcomes, a reduction in AMR, and a safer health and care environment for all.

Association of Scottish Antimicrobial Pharmacists

The Association of Scottish Antimicrobial Pharmacists (ASAP) strives to promote the specialty of antimicrobial pharmacy and provide leadership across all sectors whilst optimising patient care and clinical outcomes. As part of this group’s remit, members will support national education initiatives with the overall aim of enhancing antimicrobial management across all NHS boards within Scotland.

The Scottish Government commissioned this education framework on AMR and AMS for all non-specialist staff across all sectors. Its aim is to raise awareness of AMR and AMS whilst promoting collaborative practice around the reduction in AMR across individual roles.

ASAP fully support this piece of work as it aligns with the UK 5-year action plan for antimicrobial resistance 2024-2029. This framework will help health and social care workers, including pharmacy staff, to play a vital role in minimising AMR as part of a concerted action in Scotland to promote prudent antimicrobial prescribing for future generations.

Scottish Care

Scottish Care are delighted to support the “Containing and Controlling Antimicrobial Resistance: A Knowledge and Skills Framework for Health and Social Care in Scotland.” This framework is an important step towards giving health and social care staff in Scotland the skills and knowledge they need to tackle antimicrobial resistance. With clear advice and practical guidance, it helps our workforce make a real difference in keeping people healthy.

We would also like to acknowledge the collaborative work of NHS Education for Scotland (NES), the Scottish Antimicrobial Prescribing Group (SAPG), and Glasgow Caledonian University in developing this framework.

Scottish Care is committed to promoting best practices in infection prevention and control within social care settings. We believe that this framework will play a vital role in achieving this goal and look forward to its successful implementation.

Coalition of Care and Support Providers in Scotland

The Coalition of Care and Support Providers in Scotland (CCPS) recognises the importance of improving knowledge and skills on antimicrobial resistance and stewardship within Scottish social care settings and are committed to communicating and raising awareness of this learning framework across our provider network to assist in this.

Scottish Microbiology and Virology Forum - Public Health Scotland

The introduction of this educational framework represents a timely and vital step in Scotland’s response to the escalating public health threat of antimicrobial resistance. Aligned with national strategies, it provides all health and social care staff with the knowledge and skills needed to actively support antimicrobial stewardship. By emphasising prevention, accurate diagnosis, and a multidisciplinary approach, the framework ensures that everyone, from frontline staff to managers, can contribute to preserving the effectiveness of antimicrobials for current and future generations.

The British Society for Antimicrobial Chemotherapy

The British Society for Antimicrobial Chemotherapy (BSAC) has a longstanding commitment to providing education, training and quality improvement programmes for the prescribing workforce. BSAC fully endorses Scotland’s new multidisciplinary educational antimicrobial resistance (AMR) framework for health and social care staff and students. With a strong emphasis on antimicrobial stewardship (AMS), this framework recognises the critical importance of educating everyone involved in antimicrobial prescribing decision making and reinforces our shared responsibility in safeguarding these vital medicines to improve patient outcomes today while also protecting tomorrow’s generation.

Effective AMS demands leadership and visibility, as well as coherence and cohesion, not only across specialisms but also health and social care management and across national and regional boundaries. While this framework is designed for health and social care staff and students in Scotland, we hope it may serve as a model for wider adoption in the UK and beyond, demonstrating how local practices can be shaped by, and aligned with, emerging global standards.

BSAC looks forward to exploring how this framework can inform the development of undergraduate and postgraduate curricula, ensuring that both current and future health and care professionals are well prepared to tackle antimicrobial resistance, one of the greatest challenges in modern times.

Glossary of terms

Antimicrobials: Antiviral, antifungal, antibacterial and antiparasitic medicines.

Antimicrobial resistance (AMR): Loss of effectiveness of any anti‑infective medicine, including antiviral, antifungal, antibacterial and antiparasitic medicines (Nice, 2015).

Antimicrobial stewardship (AMS): An organisational or healthcare system-wide approach to promoting and monitoring judicious use of antimicrobials to preserve their future effectiveness (NICE 2015).

Broad-spectrum antimicrobials: Antimicrobials that act against an extensive range of disease-causing organisms.

Compassionate leadership: Compassionate leadership involves cultivating relationship through carefully listening to, understanding, empathising with and supporting other people. We all need to feel valued, respected and cared for, so we can reach our potential and do our best work.

Delphi study: A structured method of developing consensus among panel members. It usually involves several rounds of questionnaires.

Empirical treatment: Empirical treatment is a medical treatment that is given before a diagnosis is confirmed or the cause of the medical condition is fully understood. It is given based on experience.

Realistic Medicine: Realistic Medicine is an approach to healthcare that aims to put the patient at the centre of decisions made about their care. It also aims to reduce harm, waste and unwarranted variation, whilst acknowledging and managing the inherent risks associated with all healthcare, and championing innovation and improvement.

Sustainability: Sustainability refers to the responsible management of natural resources to fulfil current needs in a way that will enable future generations to meet theirs.

Value-based prescribing: Optimising the use of medicines to deliver increased value, considering patient safety, efficiency, health gains, environmental benefits/sustainability, and equity.

Acronyms

AMR

Antimicrobial resistance

AMS

Antimicrobial stewardship

ARHAI

Antimicrobial Resistance and Healthcare Associated Infections

ASAP

Association of Scottish Antimicrobial Pharmacists

AWaRe

Access Watch Reserve (classification system for antibiotics)

C. difficile

Clostridioides difficile

CPE

Carbapenemase-producing Enterobacterales

CPO

Carbapenem-Producing Organisms

ESBL

Extended Spectrum Beta-Lactamase producers

GIT

Gastrointestinal tract

HAI

Healthcare Associated Infections

IPC

Infection Prevention and Control

IV

Intravenous

IVOST

Intravenous to oral switch therapy

MDR

Multidrug resistant

MRSA

Methicillin-resistant Staphylococcus aureus

NES

NHS Education for Scotland

NEWS2

National Early Warning Score 2

NICE

National Institute for Health and Care Excellence

OPAT

Outpatient parenteral antimicrobial therapy

SANG

Scottish Antimicrobial Nursing Group

SAPG

Scottish Antimicrobial Prescribing Group

SICPs

Standard Infection Control Precautions

SMVF

Scottish Microbiology and Virology Forum

TARGET

Treat Antibiotics Responsibly, Guidance, Education and Tools

TBPs

Transmission Based Precautions

UTI

Urinary Tract Infection

VRE

Vancomycin-resistant Enterococcus

WASH

Water, sanitation and hygiene

 

Reference list

Bibliography

Literature selected as key sources for the development of the framework.

Main selection criteria

  • Competency or knowledge and skills framework
  • Framework for non-specialist staff.

Frameworks

  1. Dyar, O.J., et al (2019): ESCMID generic competencies in antimicrobial prescribing and stewardship: towards a European consensus. Clinical Microbiology & Infection, vol. 25, no. 1, 13-19.
    https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(18)30662-1/fulltext
  2. Courtenay, M. & Chater, A. (2012): Antimicrobial stewardship: a competency framework to support the role of nurses. Primary Health Care, vol. 31, iss. 2, (Mar 2021), 36-42.
    https://journals.rcni.com/primary-health-care/evidence-and-practice/antimicrobial-stewardship-a-competency-framework-to-support-the-role-of-nurses-phc.2021.e1709/abs
  3. Courtenay, M., et al (2018): Development of consensus-based national antimicrobial stewardship competencies for UK undergraduate healthcare professional education. Journal of Hospital Infection, vol. 100, no. 3, 245-256.
    https://www.journalofhospitalinfection.com/article/S0195-6701(18)30357-8/fulltext
  4. 4: Kyles, B.J. & Spivakovsky, S. (2022): Toward the development of an antibiotic stewardship competency in dental education. Journal of dental education, vol. 86, no. 7, 883-886.
    https://onlinelibrary.wiley.com/doi/10.1002/jdd.12902
  5. 5: McMaster, D., et al (2020): Consensus-based antimicrobial resistance and stewardship competencies for UK undergraduate medical students. JAC-antimicrobial Resistance, vol. 2, no. 4, aa096.
    https://academic.oup.com/jacamr/article/2/4/dlaa096/6020486
  6. Public Health England; Department of Health, Expert Committee on Antimicrobial Resistance and Healthcare Associated Infections (ARHAI) (2013): Antimicrobial prescribing and stewardship competencies.
    https://www.gov.uk/government/publications/antimicrobial-prescribing-and-stewardship-competencies
  7. World Health Organization (WHO) (2018): WHO Competency Framework for Health Workers’ Education and Training on Antimicrobial Resistance.
    https://www.who.int/publications/i/item/who-competency-framework-for-health-workers%E2%80%99-education-and-training-on-antimicrobial-resistance

Papers

  1. Davenport, L.A.P., et al (2005): 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. Journal of Antimicrobial Chemotherapy, vol. 56, no. 1, 196-203.
    https://pubmed.ncbi.nlm.nih.gov/15914493/
  1. Manning, M.L., et al (2022): A novel framework to guide antibiotic stewardship nursing practice. American Journal of Infection Control, vol. 50, no. 1, 99-104.
    https://www.ajicjournal.org/article/S0196-6553(21)00584-8/fulltext

 

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