Knowledge Award audio overview: The Protect Me poster project and reducing our cefovecin use

Elizabeth Booth BVSc PGcertSAM MRCVS:

Hi, I’m Lizzie Booth and I’m a vet working at Quarry Veterinary Group in Shrewsbury. Quarry is a small animal practice, part of the Vet Partners Group. We have got seven vets within the vet team, including a couple of certificate holders that are very much first opinion vets. So we started our antibiotic stewardship project because I identified a few areas where I
felt we could improve as a practice and I really just wanted to create more of a consensus on when and what antibiotics we should and maybe shouldn’t be using. And at the same time, if
possible, I wanted to try and reduce our cefovecin use. So what did we do? We basically took the BSAVA Protect Me poster it as a framework and started to talk about antibiotics. We did
it section by section and at the time of the RCVS Knowledge Awards, I think we’d been through the skin and the eye sections and a couple of the bits as well.

I thought it was really important for all the vets in the team to be able to be involved and to contribute to the conversation. And we found the best way to do this was to actually use the
practice management system messaging software. So I would send around a message asking first what we were currently doing in particular areas and this helped work out what we were already doing well, but also identified areas where we perhaps weren’t following the recommendations and where we could improve. I then would send around some of the guidance about what the recommendations are and perhaps where we should change and ask for feedback on this. Once everyone had had time to reply, I’d try to address any questions or concerns and identify any barriers to us changing and where I could I try and present the evidence behind the guidelines, particularly where it differed from our current practice because I know for me that really helps when I’m trying to change what I do.

Over time, the project evolved a little bit and there were various offshoots. So we did some in-house skin cytology CPD as we identified we weren’t hugely confident in this area. And the
Vet Partners Clinical Board ran some CPD on cefovecin use and that coincided nicely with what we were doing. I then retrospectively audited some of our prescribing data and I was
hugely surprised by the impact the project had had. At the time of applying for the RCVS Knowledge Awards, our cefovecin use had reduced by a massive 89% and this was the biggest change that we saw. We also saw reductions in other areas, say our prescribing of topical fusidic acid cream reduced by 50% because we’d swapped using topical antiseptics instead. Since the RCVS Knowledge Awards, we have actually carried on auditing our antibiotic use and our reduction in cefovecin use has been sustained and is still at around an 80% reduction from what it was prior to the project.

We’ve also seen our total systemic antibiotic use reduced by around 20% and improvements in other areas as well. So we’re using a lot fewer topical antibiotic containing ear preparations too. And these, they’re really huge changes and they were all down to just starting to talk about antibiotic use more and utilising some of the resources available on the RCVS Knowledge website and the BSAVA Protect Me poster. The impact it actually had on our prescribing for me was really surprising and the reduction was much greater than I was
anticipating. Credit for this needs to go to the vets who I work with who were really quite open to changing things and tolerant of me sending them lots of messages. So this kind of
project, it really can be applied to pretty much any practice and it really just shows how much bringing antibiotic use and stewardship into conversation can lead to really big and
really sustained changes. So thank you for listening and I hope I’ve encouraged some of you to just go and talk about antibiotics more and perhaps try auditing it too. The auditing
process was actually really rewarding because it was nice to be able to see where we’d actually changed. And I want to say thank you to the RCVS Knowledge Awards. We received a Highly Commended runner-up award for our project and it was really nice to be recognised for what we have achieved. So thank you.

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