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Antibiotic Guidelines A new platform for hospitals, GPs and their patients

The question: How can we most effectively get antimicrobial guidelines into the hands of the doctors prescribing antibiotics?

Our answer A single national platform that enables local antimicrobial teams to enter treatment guidelines onto a website without technical expertise, which can then be accessed on a mobile device by a doctor

AM team enters guidelines on website

Guidelines sent to mobile device

Guidelines accessed by doctor

Benefits Easier, faster access to guidelines, resulting in better care for patients through appropriate antibiotic use • Guidelines are simple to edit and always up to date • Fewer printed guidelines, environmentally friendly • Single platform for doctors nationwide: – Ongoing familiarity as move between trusts – Instant updates for doctors working in multiple sites – Always portable

• Also acts as an interactive learning platform for doctors, incorporating recommended diagnostics

What do we use at the moment? 1) Paper based guidelines (often 50+ page documents) Danger of being out of date, very slow to access

2) Intranet guidelines Relatively slow to access, sometimes difficult to search, inconsistent design between hospitals

3) Quick reference cards Quick access, but not comprehensive, may be out of date

How it works • Stage 1: Guideline collection – The antimicrobial guideline team for a trust enter their guidelines onto our website, no technical expertise needed

• Stage 2: Guideline access – Doctors download mobile application – Doctors select their hospital – The hospital guidelines are downloaded and viewed

• Stage 3: Guideline updates – The guideline team can modify guidelines with changes instantly sent to doctors the next time they access the app

Antibiotic selection – step one Doctor selects the type of body system where the infection is located

Antibiotic selection – step two

Doctor then selects the exact subtype of suspected infection This can feature interactive diagnostic protocols with key investigations

Antibiotic selection – step three The antibiotic recommended in the doctor’s hospital or primary care area is shown, with second line options and additional information: -> Pregnancy adjustments -> Renal and hepatic doses -> Dosing calculators There is also a link for each antibiotic to the entry in the antibiotic encyclopedia

Antibiotic encyclopedia A list of antibiotics used in the region Each antibiotic listing has: Cautions/contraindications Liver/renal adjustments Pregnant/breast-feeding doses Common drug side effects

Additional information Space for any information the guideline team would like to include: Introduction to app -> Overview how to use app -> Advice to only use app in particular region -> Contact if any bugs noted in app Contact -> Hospital microbiology/ID contacts Antibiotic stewardship principles -> SMART prescribing principles -> IV-oral switch advice Notifiable diseases And anything else that will be useful!

Adding and updating content Every time the antimicrobial team log in to the website, they can edit three databases

Infection guidelines Organised by body system Infinite ‘subtypes’ possible, e.g. UTI in pregnancy All text for each infection subtype can be edited, e.g. including warnings, necessary investigations, recommended referrals

Antimicrobial encyclopedia Tailor to local formulary by removing antibiotics Can edit all descriptions of antibiotics, e.g. side effects, local recommended dose adjustments Can highlight antibiotics needing micro pre-approval

Additional information Infinite sublevels possible, e.g. hospital contacts, SMART principles Calculators, e.g. gentamicin can be customised to local protocols

Why Antibiotic Guidelines? • Our single national platform creates: – Much needed consistency for doctors accessing guidelines as they move between hospitals and GP practices – Greater feedback from individual trusts and doctors to allow rapid platform improvements – Potential for integration with e-prescribing systems, microbiology laboratory data, and electronic health records – Assurance of long term support

• And, it’s financially sensible: – Target cost of £200-1000 per acute trust per annum (non-profit) – Other apps cost £2000-5000 per annum + setup fee, and often antimicrobial team cannot directly update content

Business model: non-profit, independent • Why non-profit? – Lower costs for hospitals/primary care regions – Profit from high income countries will go towards low/middle income country implementation

• Why an independent company? – Easy contracting with software developers and ongoing technical support – Quicker, more flexible responses to circumstances – Fewer information governance implications – Ability to work in multiple countries

Timeline • October-November 2013 – Interactive prototype model development

• November-January 2013 – Platform created with feedback from model – ~8 pilot trusts submit current guidelines

• January-April 2014 – Piloting in selected trusts

• April 2014 onwards – Nationwide availability

Longer term directions • Free availability of Antibiotic Guidelines in low and middle income countries where paper guidelines are scarce • Dynamic patient-centric guidelines that adapt to lab culture data, allergies, current medications, patient location/origin • Analysis of doctor interactions with app to help support local antibiotic education in targeted knowledge areas • Expansion to other guideline types, developing a standardised, accessible interface

Thank you

All screenshots are taken from existing antimicrobial guideline applications