CURRENT PLEDGES: 216884
Shared Learning 2025 – Innovation & Technology
Organisation
Arwain DGC / Welsh Lamb & Beef Producers
Project title: Farming for the Future: Calculating Livestock AMU to tackle AMR in Wales
Project Overview
Antimicrobial resistance (AMR) necessitates proactive efforts to monitor and reduce AMU in livestock. Accurate data collection and analysis are vital for designing effective interventions to combat AMR. There are specific challenges relating to agriculture and the ruminant sector where there is a lack of data available to create a baseline figure for Farm Antimicrobial Usage (AMU).
Supported by the ARWAIN DGC project, Welsh Lamb and Beef Producers (WLBP) have developed a reporting AMU Calculator tool that measures AMU on livestock farms.
The WLBP AMU Calculator is an innovative reporting tool that uses technology to capture and standardise antimicrobial (AM) sales and usage data in line with industry-agreed metrics.
WLBP is a farmer-owned co-operative with 7,000 farmer members across Wales, that runs the Farm Assured Welsh Livestock (FAWL) scheme as well as the Welsh Organic Scheme. WLBP membership covers more than 65% of the sheep breeding flock, over 65% of the beef breeding herd, and circa 90% of the dairy herds in Wales. WLBP has been actively involved and engaged with the veterinary profession since the inception of the schemes, encouraging its members to work more closely with their vets.
Veterinary surgeons play a key role in calculating AMU for enterprises under their care, a requirement for farmers participating in the Farm Assured Welsh Livestock (FAWL) scheme. They use the technology to meticulously review AM sales data, allocate purchased products to specific herds or flocks, and account for any disposed quantities to ensure accuracy.
This process culminates in a personalized AMU report for each enterprise, empowering farmers and veterinary surgeons to set informed targets aimed at improving productivity, enhancing animal welfare, and reducing antimicrobial use on beef, sheep, and dairy farms across Wales. This pioneering approach combines technology with a mandatory standards framework, strengthened by collaboration between veterinarians and farmers, to deliver shared benefits for the greater good.
Impact on tackling AMR
The WLBP AMU Calculator has emerged as a leader in the UK and Europe for AMU data collection, WLBP’s expertise has led to the design of one of the most comprehensive and effective on-farm AMU monitoring systems for Vets and Farmers.
1. Since launching in 2021 WLBP has analysed and standardised over 500,000 veterinary transactions to create a dataset that has reached over 14,500 calculations from farming enterprises across Wales. This has allowed Welsh Farmers to accurately set the AMU baseline figure (mg/kg) for Sheep, Beef, and Dairy enterprises. This allows Welsh Farmers to use the outcome of the calculations to work with their vets to set realistic targets to reduce antibiotic usage in their farming enterprises to ensure responsible use.
2. This robust system can use farm profiling data alongside AMU to recognise High AMU in livestock sectors (i.e. disease hotspots), seasonal variations linked to disease pressures (e.g., lambing, calving), and disparities in AMU between intensive and extensive farming systems. Having this data allows vets and farmers to make decisions to mitigate these risks.
3. This collaborative approach between Farmers and Vets has allowed the AMU Data to be centralised within WLBP, whilst also allowing farmers to control the movement of their data to fulfil market requirements. The data is analysed and compared to benchmark different farm enterprises and how this compares to other sectors in Wales, the UK, and Europe – a first of its kind.
As part of the Arwain DGC project, WLBP has been working with Bristol University which has investigated the relation of AMU data with AMR on 70 sampling farms in Wales. WLBP has also published publicly available independent reports that offer detailed insights into annual AMU trends across Welsh farms.
The information gathered is shared with the agriculture industry, vet profession, and government to help formulate advice for the industry and future policy.
Future Development
This industry-led data collection system empowers farmers to maintain full control over their AMU data. By adopting this voluntary approach, Welsh farmers demonstrate a proactive commitment to addressing the national challenge of antimicrobial resistance (AMR). While also, ensuring that essential antibiotics remain accessible to safeguard animal welfare.
The project is set to expand and evolve in several key areas to enhance its impact and sustainability:
• Increased Farm Participation:
Focus on engaging more farms across Wales, including smaller and more diverse operations, to ensure the dataset is as comprehensive as possible.
Enhancing Digital Tools:
Continue to improve its digital platforms, making it even easier for vets and farmers to calculate their AMU data.
Real-Time Feedback:
Developing tools that provide real-time insights and alerts to help farmers optimize antimicrobial use while safeguarding animal health and welfare.
Strengthening Veterinary Collaboration:
WLBP’s platform for vets will be further refined to ensure seamless integration of farm-level data. Vets can provide tailored recommendations and improve overall AMU stewardship within their practices.
Benchmarking and Reporting:
The planned benchmarking facility will allow vets and farmers to compare their AMU data against industry standards with the outcome of identifying areas for improvement.
Legacy Building:
By establishing a robust, long-term framework for data collection and analysis, the project will continue to benefit Welsh agriculture. This will be achieved by: By promoting collaboration between vets and farmers encouraging participation and developing and enhancing innovative technology to collect and analyse AMU data. WLBP will work with other key UK-wide industry and Government stakeholders to consider the implications and potential for adopting the European metrics for measuring AMU data.
The WLBP-led initiative has laid a robust foundation for monitoring AMU and driving targeted interventions in Welsh agriculture. This presents a significant step forward in data-driven approaches informing decision-making and fostering responsible antimicrobial stewardship, ultimately contributing to the long-term sustainability of Welsh livestock production.
Organisation
Whittington Health NHS Trust
Project title: Health Analytics in OPAT: Using smart data to improve patient outcomes and support stewardship in patients’ homes
Project Overview
Our Outpatient Parenteral Antimicrobial Therapy (OPAT) is integral to antimicrobial stewardship (AMS), providing cost-effective care, supporting admission avoidance/patient flow and improving patient outcomes. To address evolving demands, we developed an automated OPAT dashboard that consolidates real-time data on key performance indicators (KPIs), service delivery, and operational insights, enabling analysis of clinical, operational, and governance metrics.
We optimised our Electronic Patient Records (EPR) system to capture patient and microbiology data efficiently. This system was integrated with the Trust’s data warehouse, ensuring real-time storage of usable data. In addition, we created algorithms for real-time data analysis, including statistical methods and data visualisation techniques to extract meaningful insights from EPR. Analysed data was integrated with Microsoft PowerBI, allowing us to create a live, interactive OPAT Dashboard.
The PowerBI dashboard is designed to be user-friendly, providing AMS professionals with easy access to live KPI trends including: (i) patient outcomes, (ii) bed days saved, (ii) adverse events and adverse drug reactions, (iii) targeted bacterial organisms, (iv) antibiotic use, (v) resistance and bacteraemia surveillance and more. This process has streamlined and standardised data entry into patient notes, and automated high quality data capture and analysis. The OPAT dashboard has significantly enhanced service delivery, benchmarking capabilities, and governance processes, while driving patient safety and AMS priorities. By supporting business cases and fostering executive engagement, the dashboard underscores the value of integrating advanced analytics into OPAT services. This model offers a scalable framework for broader adoption across healthcare systems.
Impact on tackling AMR
1. Decreased hospital stay for more complex infections
Our OPAT dashboard has significantly enhanced our ability to confidently discharge patients with complex conditions earlier. Initially, referrals were limited to cases of pyelonephritis, diabetic foot infections, and cellulitis. However, with improved governance and support within OPAT, we now manage patients with more complex and deep-seated infections, including intra-abdominal abscesses, endocarditis, bacteraemias, and prosthetic joint infections. This has been instrumental in reducing the risk of antimicrobial resistance (AMR) transmission, acquisition, and healthcare-associated infections, thereby ensuring better patient outcomes and safety.
2. Improved monitoring of resistance trends and oversight of broad-spectrum antimicrobial usage
The dashboard has significantly improved our ability to monitor and report resistance trends to the Infection Prevention and Control Committee (IPCC). This enhancement provides the Trust with greater assurance regarding our antimicrobial stewardship efforts. For example, our data shows there has been a 110% increase in ESBL infections within OPAT over the past 12 months, which has impacted our usage of broad-spectrum antimicrobials such as Ertapenem (83% increase).
3. Increase in targeted therapy and use of ACCESS category antibacterials (WHO AWaRe)
ACCESS antibiotics are considered essential and have a lower risk of promoting antimicrobial resistance compared to WATCH or RESERVE antibiotics when used appropriately. Clinicians within our team feel more confident in using complex oral antimicrobials as the dashboard allows robust monitoring of adverse drug reactions and patient oversight. As an examples, our cot-trimoxazole usage has increased by 200% over the past 12 months. This in turn has supported earlier IV to Oral switches on OPAT. Furthermore, there has been a 62% increase in use of targeted therapy (antimicrobial prescribing guided by cultures and sensitivities) within the OPAT service as clinicians are prompted to obtain cultures when accepting OPAT referrals.
Future Development
1. Tackling health inequalities
By collecting and analysing data on patient demographics, treatment outcomes, and healthcare access, we aim to use the dashboard to highlight areas where health inequalities exist in the future. By providing transparent and accessible data, the dashboard will be able to help us engage stakeholders, including patients, healthcare providers (specific specialities), and commissioners, in efforts to reduce health inequalities
2. Remote monitoring
In the future, we aim to enhance our dashboard by integrating remote monitoring devices with our Electronic Patient Record (EPR) system. This will enable real-time data collection and seamless transmission of patient health metrics directly to the EPR and PowerBI from patient’s homes. This integration will not only improve our ability to monitor and manage patient health remotely but also support informed decision-making and proactive interventions, ultimately enhancing patient care and reducing health inequalities.
Organisation
Chelsea & Westminster NHS
Project title: Antimicrobial alert for high-risk fluoroquinolone prescribing for in-patients across multiple NHS hospitals
Project Overview
The fluoroquinolone class of antimicrobials (consisting of the commonly prescribed therapies ciprofloxacin, levofloxacin, ofloxacin and moxifloxacin) are widely used in human healthcare for the treatment and prevention of bacterial infections. Whilst a valuable and often effective treatment option of infection, there is ongoing concerns about the safety profile of this class of antimicrobials. Fluoroquinolone administration is associated with increased tendinopathy in patients on concurrent systemic corticosteroids, aged ≥60 years old and with chronic kidney disease. o provide reassurance on the safe use of fluoroquinolones, a computer decision support system (CDSS) tool was created at the Chelsea & Westminster NHS Foundation Trust to identify high-risk prescribing in real-time for the attention of the antimicrobial stewardship (AMS) team.
A rule-based alert using established CDSS (ICNET, Baxter) was introduced in Feb-2024 to the Chelsea & Westminster NHS Foundation Trust following the latest MHRA alert (Jan 2024). This alert identified the local AMS pharmacy team to all new in-patients where a systemic fluoroquinolone was prescribed with one or more concurrent systemic corticosteroids. The impact this alert on patient-level prescribing of fluoroquinolones in patients with concurrent steroids was measured retrospectively (March – July 2024) as part of this local service evaluation to demonstrate adherence to the MHRA alert. The AMS team interrogated any documented interventions made following the introduction of a fluoroquinolone with steroids, including changes to either steroid or fluoroquinolone prescription, or the provision of patient counselling on the high-risk nature of this combination.
Over four months (March – July 2024), 83 alerts highlighting concurrent fluoroquinolone and corticosteroid prescribing was generated for 81 unique in-patients across two NHS hospitals (London, UK). The median age was 70years, 46/83 were female and 12/83 had chronic kidney disease. Respiratory tract infection was the most common indication (61/83).
Impact on tackling AMR
1. Fluoroquinolone usage in high risk patients (concurrent steroids +/- age >60year old or chronic kidney disease) was actively stopped by antimicrobial pharmacy team as part of real time (Monday – Friday working only) feedback. Fluoroquinolone was stopped or switched in 48/83 cases following AMS team intervention within 48hours of initiation. Steroids were stopped in another 4 patients post-review. Ten patients continued on fluoroquinolone therapy on advice of AMS team due to limited alternative options. Eleven patients were discharged or deceased prior to review and 10 cases had no documented follow-up by the AMS team.
2. Overall fluoroquinolone prescribing reduced by 37% (DDD/1,000 admissions) at the CWFT since the MHRA alert in Jan 2024 compared to similar time period in 2022; a median reduction of 19% was seen in other NHS peer hospitals.
3. Fluoroquinolone use in high-risk patients were no alternative option was provided were counselled on the risk of tendinopathy and other fluoroquinolone related toxicities. Consent for continuing in high-risk combination therapy was documented in medical notes for transparency
Future Development
This project has continued as part of the CWFT Antimicrobial Pharmacy teams daily role. All patients on fluoroquinolones are reviewed as part of daily antimicrobial ward rounds with a bespoke alert generated for the highest risk group (steroids plus fluoroquinolone).
Organisation
All Wales Therapeutics and Toxicology Centre (AWTTC), Public Health Wales and Welsh Antimicrobial Pharmacy Group
Project title: Prescribe Wisely: Adhere to recommended antimicrobial course durations
Project Overview
Unnecessarily long courses of antimicrobials contribute to antimicrobial resistance (AMR). While the All Wales Medicines Strategy Group (AWMSG) Primary Care Antimicrobial Guidelines recommend prescribing the shortest effective antibiotic courses for acute respiratory tract infections (RTIs), data from Welsh primary care shows considerable variation across healthboards.
Swansea Bay University Healthboard (SBUHB) Medicines Management Team utilised prescribing decision support software (ScriptSwitch) to highlight key prescribing messages and suggested quantity switches at the point of prescribing in GP practices. Simple messages were written and deployed to trigger when prescribing specific antibacterials, aiming to reduce the quantity supplied. Data collected on the acceptance rates of the suggested switches showed a positive outcome, with an acceptance rate exceeding 20%.
Building on the success of SBUHB’s ScriptSwitch messages, the All Wales Therapeutics and Toxicology Centre (AWTTC) collaborated with Public Health Wales (PHW) and Welsh Antimicrobial Pharmacy Group to ensure key antimicrobial prescribing messages and suggested quantity switches were visible to primary care prescribers across Wales. This national initiative resulted in the development of prescribing messages for course durations of amoxicillin, doxycycline, clarithromycin, and phenoxymethylpenicillin for the treatment of uncomplicated RTIs. The messages do not add additional workload to practices and are triggered when antimicrobials are prescribed for durations longer than 5-days, recommending a reduction to 5-days. From July 2024, the prescribing messages and suggested quantity switches were published in the AWTTC ScriptSwitch library for healthboards to use. The “Once for Wales” approach ensures consistent, evidence-based messages, eliminating duplication of effort by healthboards and allowing them to import and deploy antimicrobial course duration messages to local GP practices.
Overall, from August to November 2024, 23.25% of 11,910 prescription items across all four antibacterials were switched to a 5-day course duration. This project safely reduced patient exposure to antimicrobials and helped combat AMR by promoting the shortest-effective course.
Impact on tackling AMR
Reduction in antimicrobial prescribing
Six out of seven healthboards in Wales use ScriptSwitch, and all have implemented prescribing messages and suggested quantity switches for amoxicillin (500mg), clarithromycin (500mg), doxycycline (100mg) and phenoxymethylpenicillin (250mg). From August to November 2024, acceptance rates were 28.47% (3,285 items), 26.00% (2,524 items), 18.23% (5,777 items), and 38.89% (324 items) respectively. This prompted prescribers to reduce the treatment duration for uncomplicated RTIs to 5 days, in line with guidelines. This also resulted in a reduction in Defined Daily Doses (DDDs), reflecting the overall decrease in antimicrobials prescribed. The project supports Wales’ antimicrobial usage goals and the UK’s national AMR targets, while optimising healthcare resources and reducing costs.
Once for Wales approach
The project was extended from SBUHB to adopt an All-Wales approach for developing prescribing messages for course durations. This reduced duplication of effort across healthboards, allowing antimicrobial pharmacy teams to allocate their limited time to other local antimicrobial stewardship (AMS) initiatives. As a result, additional national prescribing messages were developed, including course durations for UTI antibacterials and safety messages for fluoroquinolones in response to MHRA alerts.
Development of a new National Prescribing Indicator (NPI)
Aligned with the AWMSG Strategy for Wales: 2024-2029, the NPIs aim to reduce inappropriate variation in prescribing by promoting evidence-based practices. A new antimicrobial NPI for 2025-2028 has been introduced, focusing on RTIs, aiming to reduce the length of antibacterial courses to the shortest-effective duration e.g, reducing amoxicillin treatment from 7 to 5 days. The prescribing messages and suggested switches developed support practices and healthboards in achieving AWMSG antimicrobial NPI targets.
Spread & Scale
This initiative has been shared to a range of healthcare professionals at national events, including AWTTC Learning at Lunch sessions (>200 attendees), PHW AMR meetings, and PHW AMS conference, expanding its reach and impact in combating AMR.
Future Development
By continuing to spread and share these prescribing messages through education awareness at both a national and local level, we aim to increase the acceptance rates of the prescribing messages and suggested quantity switches. We will highlight national antimicrobial targets and demonstrate how adopting these switches supports antimicrobial usage reduction goals, helping GP practices meet AWMSG antimicrobial NPI targets. We will also ensure that prescribing recommendations are regularly updated to maintain their relevance and value for prescribers.
This is an ongoing collaboration involving AWTTC, Public Health Wales, and the Welsh Antimicrobial Pharmacy Group. We are currently developing course duration messages using OptimiseRx, this is the other prescribing decision support software used in primary care within Wales. This ensures that all GP practices in Wales have access to the same messages and switches. Working together to develop standardised prescribing messages, focused on AMS and resistance, saves duplication of effort by health boards. We will continue to explore further opportunities to develop national AMS messages.
AWTTC has developed a dashboard on the Server for Prescribing Information Reporting and Analysis (SPIRA) to report on course durations for antibacterials used in the treatment of uncomplicated respiratory tract infections (RTIs). Set to launch in January 2025, this online, interactive tool will enable comparative analysis of prescribing data across health boards, clusters and GP practices in Wales. The dashboard will allow users to drill down to practice level, providing insight into prescribing patterns, including whether practices are following the recommended 5-day antimicrobial course durations. The data will enable health board antimicrobial pharmacy teams to target any interventions that may be necessary. This dashboard will be accessible to all healthcare professionals in Wales with access to the NHS Wales network, supporting AMS and promoting appropriate antimicrobial prescribing.
Educating the public and raising awareness about short course durations for antibacterials is crucial. This may be incorporated into future national stewardship campaigns in Wales, led by AWTTC as part of the “Your Medicines, Your Health” initiative. Promoting responsible antimicrobial use through public education will improve health outcomes and help preserve the effectiveness of this valuable resource for future generations.
