Call for more nurse prescribers to fight antimicrobial resistance

The call comes from the Royal College of Nursing in Wales, which warned that nurses were central to achieving the government’s aims for reducing infections and the use of antimicrobial prescriptions over the next 20 years.

“The Welsh government should consider increasing the number of nurse prescribers”

Helen Whyley

The plea follows a letter, signed by health leaders including chief nursing officer for Wales Professor Jean White, which gave Welsh health boards and trusts a list of improvement goals for 2019-20 regarding antimicrobial prescribing and healthcare-associated infections.

The improvement goals for Wales aims to build on the UK-wide strategy for antimicrobial resistance, which has the ambition to reduce antimicrobial consumption in primary care by 25% from baseline year of 2013, by 2024.

Health bosses in Wales want to reflect the UK target and have stated that primary care services will be expected to achieve the same reduction target.

According to the letter, during 2018-19, primary care prescribing of antimicrobials has continued to reduce and builds on the 12% reduction in prescribing seen in 2013 and 2017.

However, the letter flagged that there was still a “wide variation of practice” across services in wales.

In terms of hospital care, it noted that there were currently no health boards on target to achieve the 5% reduction in total volume of antimicrobials set for 2018-19.

One improvement goal set for Welsh health boards is a 1% reduction in total antimicrobial usage in hospital care in 2019-20, against 2018-19 consumption figures.

“Infection prevent and control nurses have unique skill sets”

Helen Whyley

In addition, the letter sets out a series of goals for lowering the burden of infection.

It noted that reductions in Clostridium difficile (C. difficile) were particularly impressive in 2018-19, with 27% fewer cases of C. difficile were recorded across Wales as compared with 2017-18.

The targets for 2019-20 calls on health boards to reduce to a rate of 25 cases per 100,000 population.

The goals also require health boards that have achieved their 2018-19 reduction expectations, to reduce their 2018-19 rate by a further 10% in 2019-20.

For Escherichia coli (E.coli) blood stream infections, Wales has seen 5% fewer cases than in 2017-18 and 24% fewer cases in meticillin resistant Staphylococcus aureus (MRSA) blood stream infections than in 2017-18.

The improvement goal for Wales in terms of E.coli blood stream infections is for a reduction rate of 67 cases per 100,000.

The letter, isused earlier this month, also states that for 2019-20, there will be zero tolerance of MRSA bacteraemia, with further reductions expected.

helen whyley

helen whyley

Source: RCN Wales

Helen Whyley

In response, the director of RCN Wales, Helen Whyley, told Nursing Times that the role of nursing in the reduction of infections and the use of antimicrobial prescriptions and in achieving the UK-wide strategy, “cannot be under-estimated”.

“Nursing is clearly central to achieving this,” she said. “Evidence shows that nurse prescribers bring down antimicrobial resistance prescriptions and the Welsh government should consider increasing the number of nurse prescribers in the community if they want to achieve these improvement goals.

“Infection prevent and control nurses have unique skill sets and work in multi-disciplinary teams,” said Ms Whyley.

“We welcome the model of a centrally managed but locally focused community infection prevention resources, however, we will be exploring why the infection prevention and control (IPC) nurses are lower grade roles that the community antimicrobial pharmacists,” she told Nursing Times.

“We look forward to see the details of the way forward for this model and particularly the funding for this model in the near future,” she said.