Changes to antimicrobial susceptibility reporting from microbiology laboratory from 3rd May 2022 | Right Decisions

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Changes to antimicrobial susceptibility reporting from microbiology laboratory from 3rd May 2022

Announcements and latest updates

Welcome to the Right Decision Service (RDS) newsletter for August 2024.

Contingency planning for RDS outages

Following the recent RDS outages, Tactuum and the RDS team have been reviewing the learning from these incidents. We are committed to doing all we can to ensure a positive outcome by strengthening the RDS to make it fully robust and clinically resilient for the future.

We would like to invite you to a webinar on 26^th September 3-4 pm on national and local contingency planning for future RDS outages. Tactuum and the RDS team will speak about our business continuity plans and the national contingency arrangements we are putting in place. This will also be a space to share local contingency plans, ideas and existing good practice. We would also like to gather your views on who we should send communications to in the event of future outages.

I have sent a meeting request for this date to all editors – please accept or decline to indicate attendance, and please forward on to relevant contacts. You can also contact Olivia.graham@nhs.scot directly to register your interest in participating.

2.National IV fluid prescribing calculator

This UK CA marked calculator is now live at https://righdecisions.scot.nhs.uk/ivfluids . It has been developed by a multiprofessional steering group of leads in IV fluids management, as part of the wider Modernising Patient Pathways Programme within the Centre for Sustainable Delivery. It aims to address a known cause of clinical error in hospital settings, and we hope it will be especially useful to the new junior doctors who started in August.

Please do spread the word about this new calculator and get in touch with any questions.

New toolkits

The following toolkits are now live;

Gender identity healthcare: adults and young people standards. (https://rightdecisions.scot.nhs.uk/genderidentity ) Note that this toolkit includes self-evaluation forms for each standard. A Scottish Government launch of these standards, together with the toolkit and NES educational resources, is planned for 3^rd September.
Care Inspectorate staffing method framework.
Vascular surgery pathways from the Modernising Patient Pathways Programme within the Centre for Sustainable Healthcare Delivery.

Updated guidance on current and future Medical Device Regulations

We have updated and simplified this guidance within our standard operating procedures. We have clarified the guidance on how to determine whether an RDS tool is a medical device, and have provided an interactive powerpoint slideset to steer you through the process.

Guide to six stages of RDS toolkit development

We have developed a guide to support editors and toolkit leads through the process of scoping, designing, delivering, quality assuring and implementing a new RDS toolkit. We hope this will help in project planning and in building shared understanding of responsibilities throughout the full development process. The guide emphasises that the project does not end with launch of the new toolkit. Implementation, communication and evaluation are ongoing activities throughout the lifetime of the toolkit.

Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

Thursday 5 September 1-2 pm
Wednesday 24 September 4-5 pm
Friday 27 September 12-1 pm

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

7 Evaluation projects

Dr Stephen Biggart from NHS Lothian has kindly shared with us the results of a recent survey of use of the Edinburgh Royal Infirmary of Edinburgh Anaesthesia toolkit. This shows that the majority of consultants are using it weekly or monthly, mainly to access clinical protocols, with a secondary purpose being education and training purposes. They tend to find information by navigating by specialty rather than keyword searching, and had some useful recommendations for future development, such as access to quick reference guidance.

We’d really appreciate you sharing any other local evaluations of RDS in this way – it all helps to build the evidence base for impact.

If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

With kind regards

Right Decision Service team

Healthcare Improvement Scotland

Reporting of antimicrobial susceptibility testing results from microbiology laboratories is changing in line with new European (EUCAST) recommendations. Antibiotic susceptibility will be reported as I as well as the more familiar S and R. Antibiotics reported as I are effective treatment options when given at higher dose and should not be avoided. The new definitions of these are listed below

S	Susceptible at standard dose
I	Susceptible, at increased exposure/increased dose
R	Resistant even with increased exposure/dose

Many reports will be unchanged but below are the situations you are more likely to see I reported or a comment indicating high dose should be used.

Organism	Agents affected	Comment
Pseudomonas aeruginosa	Piperacillin-tazobactam Ceftazidime Ciprofloxacin	Please consider whether treatment is required if reported from a non-sterile site
Haemophilus influenzae	Oral (not IV) amoxicillin Oral (not IV) co-amoxiclav
Streptococcus sp	Levofloxacin	High dose already in routine use
E.coli	Temocillin	Protected antibiotic Please avoid using this agent if another can be safely used.

Please see table overleaf for full list of antimicrobials and doses recommended in adults if reported as
For paediatrics please refer to id-944-isolates-reported-as-i.pdf (scot.nhs.uk).
For dosing advice in extremes of weight please discuss with Antimicrobial Pharmacist.
Refer to the https://bnf.nice.org.uk/ and www.medicines.org.uk for advice on dosing in renal or hepatic impairment but taking into account the higher dose required to treat these organisms effectively. If in doubt discuss with Antimicrobial Pharmacist.
In certain situations (eg endocarditis), increased doses are recommended even if the antimicrobial is reported as “Susceptible at standard dose” (S). These cases should be discussed with a Microbiologist.
Dosing recommendations below should only be used when reviewing antimicrobial susceptibility results and do not replace referring to the Empirical Antibiotic Therapy Infection Management Guidelines.

Table listing recommended dose for antibiotics — Table updated 2024

Dosing of topical agents is largely unaffected by this change. Refer to https://bnf.nice.org.uk/ and https://medicines.org.uk for dosing guidance.