Knowledge Award audio overview: Reduction of highest-priority critically important antibiotic use by Animal Trust, Dewsbury

Tighearnan Mooney, BVMSci CertAVP PGCertVPS MRCVS

Hi, my name is Tighearnan Mooney. I’m the Lead Vet at Animal Trust, Dewsbury. Animal Trust is a Community Interest Company which strives to improve access to affordable, high quality care across Yorkshire, Greater Manchester, Shropshire, Merseyside and North Wales.

Back in July 2023, I performed a clinical audit to review my team’s use of highest priority critically important antibiotics, those being cefalexin, fluoroquinolones and polymyxin B. I found that our use of HPCIAs was relatively low with approximately 3% of our consults being prescribed a drug of this class, but there was room for improvement.

The vet and nursing teams discussed our use of HPCIAs to discuss reasons for their use as well as barriers to not using them. The main actions taken at this meeting were that vets committed to being more conscientious of HPCIA stewardship and to add details of why they prescribed HPCIAs into their clinical notes to aid with further auditing and practice policy changes. We also identified and encouraged the use of a lower cost culture and sensitivity panel.

This approach saw some improvement. During the next audit cycle, only 1.6 % of our consults received a HPCIA and the majority of vets documented why they felt a HPCIA was required. However, there was still room for improvement. After further discussion with the team, we
made several changes to the drugs that we stocked, working off the idea that if lower priority antimicrobials were available and access to HPCIAs was less instantaneous, then we could encourage better habits.

These changes resulted in further improvements in our use of HPCIAs. By February 2024, our use of cefalexin had dropped to zero and our overall use of HPCIAs had dropped to 0.46% of consults. Shortly later, our last bottle of cefalexin went out of date and the team agreed to stop stocking it. Longer term, our HPCIA use has remained consistently low, averaging around 0.4% of consults.

This project in Dewsbury galvanised a similar organisation-wide focus on HPCIA stewardship, which is an ongoing major focus of the clinical governance team at Animal Trust. Our work has been built upon, and we now have quarterly reviews of HPCIA use across all Animal Trust
sites with standardised metrics. Several other clinics have achieved similarly impressive changes in their HPCIA prescriptions.

The key things that I learned from this project are that when making changes like this, you need to have input and buy-in from your entire team. The vets who prescribe the drugs, as well as the nurses and ACAs who dispense them and are responsible for your stock control. You and your team may be able to make reasonable and effective changes, but without completing at least one full audit cycle, there will be things that you miss.

What you have on the shelf matters. If it’s the day before the order comes in and all you have available is a HPCIA, then you’re probably going to use that drug. Try and make sure that there’s always at least one first line option available. Better still, have several differently
formulated first line options on the shelf. And finally, it is possible to work in small animal practice and not use or stock cefalexin.

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