Data for Action: Improving Antibiotic Use by Strengthening Data Interpretation
Exploring how SPARC’s ‘Data for Action’ workstream empowers facilities to tackle AMR
by Kelly Alexander, Antimicrobial Resistance Technical Lead, SPARC
An important aspect in developing targeted antimicrobial stewardship (AMS) interventions is the collection of antimicrobial use (AMU) data. This process ensures AMS is not based on guesswork but instead allows healthcare professionals to precisely identify inappropriate AMU, empowering them to undertake evidence-based actions to slow the development of antimicrobial resistance (AMR) and improve patient outcomes.
But it is not enough to simply collect data. Facilities are not always equipped to convert their data into knowledge, and barriers exist to their understanding of their AMU challenges and using this understanding to change practice and behaviours. Without this step, we cannot achieve better AMU, and we cannot progress towards reducing AMR.
Data for Action, a component part of the Commonwealth Pharmacists Association’s Surveillance and Prescribing Support for AMS Resource Capacity Building (SPARC) programme, provides training to address this gap.
The course not only works to improve participants’ capability to collect and interpret AMU data, but also supports the design of evidence-based interventions and seeks to strengthen leadership, advocacy, and behaviour change skills to improve AMS. It is a comprehensive bundle of resources which empowers participants and, ultimately, their health facilities to conduct sustainable interventions to tackle AMR.
The Data for Action course is delivered through four structured training modules. Each is intended to equip participants with key knowledge, skills and experiences to apply to real-life situations in their own facilities as they champion AMS.
Leadership and accountability development
This module covers how to set up an AMS committee, the integration of the committee into the hospital governance/leadership structure, and the functions of the committee in defining the AMS programme. Participants gain practical experience in completing the World Health Organisation facility AMS assessment tool, as well as learning how to identify priorities and develop AMS action plans, empowering them to support their facilities in independently developing their local action plans according to their strengths and needs.
Strong and integrated leadership is critical for driving improvement and overseeing organisational change.
Point prevalence survey: data collection
Point prevalence surveillance (PPS) provides a mode of measuring AMU data. The benefit of PPS is that data on antibiotics is patient-level, so it gives information about how antibiotics are used, including for what condition or indication, and the level of compliance with guidelines and culture and sensitivity results. Therefore, PPS provides insights into how appropriate prescribing currently is, and gives insights as to where to target interventions to improve this.
Point prevalence survey: data analysis
It goes without saying: if the results are never analysed, there is no point in collecting that data.
The course also provides practical experience in interpreting PPS data to identify themes of prescribing practices. This is a critical skill for planning and monitoring AMS programmes to support interventions to improve prescribing and antimicrobial use.
Data use and behaviour change
After collecting the evidence and identifying what needs to be improved, the next step to effective and sustainable change is to understand why. As we prescribe and “use” antimicrobials, our activities are underpinned by a variety of behaviours, belief sets and environmental factors. By understanding the motivators or drivers for a person’s behaviour and using this as we design interventions or quality improvement projects, the interventions are much more likely to have the desired impact.
Imagine, for example, that I disproportionately prescribe ceftriaxone due to the fact that it is the only antibiotic stocked on my ward and I want my patients to receive their treatment as quickly as possible. In this scenario, feeding back audit results or giving me a new guideline book will have a limited effect on my prescribing behaviours compared to reviewing the stock on the ward and ensuring antibiotics outlined in the guidelines are readily available.
Earlier this year, CPA delivered Data for Action training to representatives from secondary care healthcare facilities in five countries: Malawi, Nepal, Nigeria, Timor-Leste, and Zimbabwe. The two-day in-person training was supplemented by online e-learning modules, a training manual, and virtual post-course sessions. A further six countries received the behaviour change training module as part of our Commonwealth Partnerships for AMS (CwPAMS) programme.
Building on the training, participants are supported by In-Country Consultants and WhatsApp-based communities of practice, encouraging peer-to-peer support and shared learning.
Having completed the modules, participants should now be empowered to work within their own facilities to conduct PPS, analyse their findings, and develop AMS structures and interventions that respond to local priorities using behaviour change theories to sustainably improve practice and AMU.
Impact
In the course’s feedback survey, 96% of participants said that they would recommend Data for Action to a colleague working in AMS, and 100% found the course to be easy to understand. You can read testimonials from some participants below.
“Being a clinician and also infection prevention and control focal person, I really liked the training. It will help to improve in many aspects of care provided at my facility and the whole country at large.” – Malawi
“It was a wonderful training where I have gained much knowledge on PPS, which will eventually help in monitoring and combating AMR.” – Malawi
“It was an extremely impactful workshop.” – Nepal
“This workshop and the support received so far have been very useful to strengthen AMS in our hospital. Thank you.” – Nigeria
“This course is very good, because all the material presented is very easy for me to understand. My input for the future is to keep it like this.” – Timor-Leste
“Thank you very much for this very important training, which is a global issue and would promote appropriate use of antibiotics.” – Zimbabwe
We in the SPARC team have been truly inspired by what the facility teams have achieved so far, and are looking forward to our final Sharing and Learning Event in February.
About the author
Kelly Alexander
AMR Technical Lead, SPARC
About the author
Kelly has 20 years of experience working in AMS in the UK. Principally working for NHS organisations, she has held lead AMR pharmacist posts within NHS acute trusts and has worked at a system level across primary and secondary care.
Kelly utilises her extensive experience in developing and leading AMS improvement schemes as the AMR Technical Lead for the SPARC programme, having previously led on the development of the CwPAMS AMS Toolkit.
About SPARC and the Fleming Fund
Led and implemented by the Commonwealth Pharmacists Association, the SPARC programme is supported through a grant from the Department of Health and Social Care’s Fleming Fund, a UK aid programme supporting up to 25 countries across Africa and Asia to tackle AMR, managed by Mott MacDonald. The Fleming Fund invests in strengthening data surveillance systems through a portfolio of country grants, regional grants, fellowships and global projects managed by partners.