The National Implementation of a Community Pharmacy Antimicrobial Stewardship Intervention (PAMSI) through the English Pharmacy Quality Scheme 2020 to 2022

Abstract

Since 2020, England’s Pharmacy Quality Scheme (PQS) has incentivised increased antimicrobial stewardship (AMS) activities in community pharmacy. In 2020/21, this included the requirement for staff to complete an AMS e-Learning module, pledge to be an Antibiotic Guardian and develop an AMS Action plan. To build and embed these initiatives, in 2021/22, the PQS required the use of the TARGET Antibiotic Checklist (an AMS tool for use when patients present with a prescription for antibiotics to support conducting and recording of a series of safety and appropriateness checks against each prescribed antibiotic). This paper describes the implementation of the national PQS criteria from 2020 to 2022, and details community pharmacies’ AMS activities and barriers to implementation of the 2021/22 criteria. A total of 8374 community pharmacies submitted data collected using the TARGET Antibiotic Checklist for 213,105 prescriptions; 44% surpassed the required number for the PQS. Pharmacy teams reported checking the following: duration, dose, and appropriateness of antibiotics; patient allergies and medicine interactions (94–95%); antibiotic prescribing guideline adherence (89%); and the patient’s previous use of antibiotics (81%). The prescriber was contacted for 1.3% of TARGET Antibiotic Checklists (2741), and the most common reasons for such contacts were related to dose, duration, and possible patient allergy. A total of 105 pharmacy staff responded to a follow-up questionnaire, which suggested that some AMS principles had been embedded into daily practice; however, the necessary time commitment was a barrier. The PQS was able to incentivise mass AMS activities at pace over consecutive years for England’s community pharmacies simultaneously. Future research should monitor the continuation of activities and the wider impacts on primary care.

The Use of the TARGET Antibiotic Checklist to Support Antimicrobial Stewardship in England’s Community Pharmacies

“…Over 200,000 data entries were collected as part of this PQS criteria from all over England, one of the largest studies conducted on community pharmacies to date [ 17 ]. This quantitative analysis highlighted the role that community pharmacies can play in promoting AMS activities amongst their patient population and how, collectively, this will contribute to reducing AMR [ 34 ].…”

“…Data cleaning helped to remove duplicate entries, erroneous entries, and data absence. It could also be argued that pharmacy teams may behave differently to usual practice when taking part in an incentivised scheme such as the PQS, with potential temporary changes in behaviours; however, more checklists were submitted than were required for the purposes of the PQS and there is a known continuation of resource use post intervention period [ 17 ]. Additionally, it is challenging to estimate the longer-term impact and sustainability of this PQS scheme in the absence of national standards/framework for community pharmacies and antimicrobial stewardship to tackle antimicrobial resistance.…”

Responding to Urinary Tract Infection Symptoms in England’s Community Pharmacies

“…These services can potentially improve access to treatment for women experiencing these symptoms of UTIs. In addition, community pharmacy teams have undertaken national training and participated in PQS criteria for risk management, sepsis recognition, identifying and assessing the risk of missing red flag symptoms during over the counter (OTC) consultations, AMS and infection control training, and pledging to become antibiotic guardians [ 16 ]. This requires members of the community pharmacy team to make a pledge stating how they will make better use of antibiotics and help preserve the effectiveness of these vital medicines (the introduction of the Antibiotic Guardian pledge as part of the PQS in 2020/21 led to a vast increase in UK pledges from community pharmacy teams in 2020, which has been sustained) [ 16 ].…”

“…The PQS criteria were developed by NHS England in collaboration with the United Kingdom Health Security Agency (UKHSA) and the Pharmaceutical Services Negotiating Committee (PSNC) (now known as Community Pharmacy England). The specific requirement to implement the use of the TARGET TYI leaflets was built on previous AMS activities included in PQS Year 2020–21 and 2021–22 [ 16 , 17 ].…”

“…Since 2020, the PQS has incentivised the increased role of community pharmacy teams in AMS, adding and renewing initiatives for community pharmacies to help embed them into day-to-day practice [ 16 , 17 ]. In 2022–23, the PQS incentivised the use of the TARGET Treating Your Infection (TYI) leaflets for UTIs and Respiratory Tract Infections (RTIs) for pharmacy staff responding to urinary and respiratory symptoms for walk-in patients [ 18 ].…”