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

Abstract

Antimicrobial Stewardship (AMS) requires effective teamwork between healthcare professionals, with patients receiving consistent messages from all healthcare professionals on the appropriate antimicrobial use. Patient education may reduce patients’ expectations to receive antibiotics for self-limiting conditions and reduce the pressure on primary care clinicians to prescribe antibiotics. The TARGET Antibiotic Checklist is part of the national AMS resources for primary care and aims to support interaction between community pharmacy teams and patients prescribed antibiotics. The Checklist, completed by the pharmacy staff with patients, invites patients to report on their infection, risk factors, allergies, and knowledge of antibiotics. The TARGET antibiotic checklist was part of the AMS criteria of England’s Pharmacy Quality Scheme for patients presenting with an antibiotic prescription from September 2021 to May 2022. A total of 9950 community pharmacies claimed for the AMS criteria and 8374 of these collectively submitted data from 213,105 TARGET Antibiotic Checklists. In total, 69,861 patient information leaflets were provided to patients to aid in the knowledge about their condition and treatment. 62,544 (30%) checklists were completed for patients with an RTI; 43,093 (21%) for UTI; and 30,764 (15%) for tooth/dental infections. An additional 16,625 (8%) influenza vaccinations were delivered by community pharmacies prompted by discussions whilst using the antibiotic checklist. Community pharmacy teams promoted AMS using the TARGET Antibiotic Checklist, providing indication-specific education and positively impacting the uptake of influenza vaccinations.

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

“…In 2021–22, the AMS criterion included the use of the TARGET Antibiotic Checklist for any patient presenting with an antibiotic prescription to educate them about antibiotics and promote AMS [ 31 ]. As a result of these consecutive AMS initiatives, community pharmacy teams can effectively counsel and advise patients presenting with antibiotic prescriptions for dispensing as well as those attending the pharmacy for advice and responding to symptoms in the management of common conditions such as a UTI [ 17 ].…”

“…Much like related PQS studies, the data have a high level of ecological validity, where the focus was to promote AMS and the data collected and analysed were from everyday practice over the duration of the scheme [ 17 , 33 ]. Over 100,000 data entries were collected as part of this PQS from across England, making it one of the largest studies conducted in community pharmacies to date.…”

“…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 ].…”

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

“…The clinical checks completed by the pharmacy team, as well as whether the prescriber was contacted to discuss the prescription, are reported. The accompanying patient data from the TARGET Antibiotic Checklist are reported separately [ 19 ]. A follow-up questionnaire with a sample of participating pharmacy staff aimed to explore continued use of the resources and implementation barriers.…”