TARGET Antibiotic Toolkit

Updates

All TARGET resources are reviewed every 2 – 4 years, depending on the specific resource, or more frequently if there are significant developments in the field. Any resource changes will be highlighted here

• TARGET resource revision schedule

News

We publish 4 TARGETantibiotics newsletters a year (February, May, September, November) highlighting resource updates, new developments, publications and any planned future work that you may wish to be involved in. If you would like to be mailed the newsletter directly contact us: TARGETantibiotics@phe.gov.uk

• March 2018 - TARGET antibiotic newsletter – Vol 2

• November 2017 - TARGET antibiotic newsletter - Vol 1

External Review: How to prevent urine infections (UTIs) and what to do if you have one – a leaflet for older adults

The UTI leaflet for older adults has been designed to use with older adults who are “at risk” for or have a suspected UTI and those who care for them.  The leaflet has been developed in partnership with primary care providers, care home staff, residents, family members and other experts and is currently open for external review. It is not yet ready for general use.

We are seeking feedback and comments regarding this leaflet over the next month, deadline: 15th December, 2017.

Please provide feedback using the corresponding online survey or by e-mail.

• Older adult UTI leaflet - public consultation [PDF]
• Older adult UTI leaflet - public consultation - Referenced [PDF]
• Leaflet references and rationale - public consultation [DOC]

Your feedback is extremely valuable to us and will be used to make final revisions and changes before publication.

TARGET treating your infection (TYI) leaflets

The TYI patient information leaflets are designed to be shared with patients during the consultation and aim to facilitate communication between prescriber and patient, and increase patient’s confidence to self care. The leaflets include information on illness duration, self-care advice, prevention advice and advice on when to re-consult. For any leaflet queries please contact us: TARGETantibiotics@phe.gov.uk

Treating your infection - URINARY TRACT INFECTION (TYI-UTI) leaflet

The TYI-UTI patient Information leaflet has been designed to be used with women who are experiencing urinary symptoms suggesting non complicated UTIs.

This leaflet supports implementation of recommendations in the NICE guidelines on processes for antimicrobial stewardship and behaviour change for antimicrobial stewardship.

• TARGET TYI-UTI patient  leaflet – V18 [PDF] [DOC]
• TARGET TYI-UTI fully referenced leaflet
• TARGET TYI-UTI leaflet user guide
• Upload the TARGET TYI-UTI leaflet onto SystmOne

TYI-UTI leaflet translations

• Albanian 
• Arabic
• Bengali
• Cantonese
• French
• Greek
• Gujarati
• Hindi
• Hungarian
• Mandarin
• Polish
• Portuguese
• Punjabi
• Romanian
• Somali
• Spanish
• Turkish
• Urdu
• Welsh

Treating your infection – RESPIRATORY TRACT INFECTION (TYI-RTI) leaflet

The TYI-RTI patient Information leaflet has been designed to be used with patients who are experiencing self limiting URTIs.

This leaflet supports implementation of recommendations in the NICE guidelines on processes for antimicrobial stewardship, behaviour change for antimicrobial stewardship and antibiotic prescribing for respiratory tract infections.

• TARGET TYI – RTI patient  leaflet – V8 [PDF] [DOC]
• TARGET TYI-RTI fully referenced leaflet V8 [PDF] [DOC]
• TARGET TYI – RTI leaflet user guide V4
• Upload the TARGET TYI-RTI onto your GP system [EMIS] [SystmOne]

TYI-RTI leaflet translations

• Albanian
• Arabic
• Bengali
• Cantonese
• French
• Greek
• Gujarati
• Hindi
• Hungarian
• Mandarin
• Polish
• Portuguese
• Punjabi
• Romanian
• Somali
• Spanish
• Turkish
• Urdu
• Welsh

TYI-RTI leaflet for other clinical settings 

• TYI-RTI leaflet for out of hours clinics - V8 [DOC] [PDF]
• TYI-RTI leaflet for community pharmacies - V8 [DOC] [PDF] 

TYI-RTI pictorial leaflet – simplified version 

• Pictorial Managing Your Infection TYI-RTI leaflet V2 [PDF]
• Pictorial Managing Your Infection TYI-RTI leaflet - WELSH V2 [PDF]
• Pictorial Managing Your Infection TYI-RTI leaflet– Condensed version V2 [PDF]
• Pictorial Managing Your Infection TYI-RTI leaflet User Guide V3 [DOC]

Other useful leaflets (not developed by TARGET)

Public Health England Stool collection leaflet (click on the picture to download the leaflet)

The stool collection leaflet is a step-by-step guide illustrating how to collect a stool sample for microbiological examination.

Antibiotic guardian leaflet (click on the image to download the leaflet)

Part of the dental antimicrobial stewardship toolkit for primary care, this leaflet highlights why antibiotics don't cure toothache and provides safety netting advice. 

When should I worry? Booklet for parents and carers (click on the image to download the booklet)

The 'When Should I Worry?' booklet provides information for parents about the management of respiratory tract infections such as coughs, colds, sore throats and ear aches in children. It is designed to be shared in consultations. 

Caring for children with coughs leaflet (click on the image to download the leaflet)

This leaflet contains information about how to look after a child who has a cough (not due to asthma).

Get well soon without antibiotics leaflet (click on the image to download the leaflet)

This leaflet, produced by the Department of Health, explains the need to get the right treatment for common illnesses such as colds and coughs without encouraging antibiotic resistance. It is available in different languages and is suitable for distribution in waiting areas.

Antibiotics Don’t Cure Toothache (click on the image to download the leaflet)

Part of the dental antimicrobial stewardship toolkit for primary care, this leaflet highlights why antibiotics don't cure toothache and provides safety netting advice. 

Self-care forum fact sheets

The Self-Care Forum is dedicated to helping people take care of themselves and as such, have created a series of self-care fact sheets for common ailments which aim to help clinicians and patients discuss issues around self-care during consultation and especially how to handle the symptoms in the future. 

• Fever in children [PDF]
• Cough [PDF]
• Acne [PDF] 
• Sore throat [PDF]
• Otitis media [PDF]
• Common cold [PDF]
• Urine symptoms in men [PDF]

Posters and videos for use in clinical areas to raise awareness of the importance of prescribing antibiotics appropriately. The resources can make a difference to the patients’ expectations on antibiotic prescribing.

Posters

Click on the image to download the resource

Videos 

Access the Department of Health videos to be displayed on TVs in patient waiting areas: 

Click on the image to download the resource

Department of Health

Health Education England (HEE) 

The HEE antimicrobial resistance animation intends to assist prescribers when they are faced with somebody who incorrectly feels they should be prescribed an antibiotic. 

Could you be an external reviewer?

We have updated our audits and, for ease of use, have developed them in both MS Word and MS Excel format; these updates can be found below for external review. As an external reviewer we would ask you to:

1. Choose at least one audit  and read both the Word and Excel versions 
2. Carry out an audit of your prescribing using wither the Word or Excel version
3. Let us know your thoughts on the audits by completing the audit evaluation form

Your feedback will help us further improve the audits.

Acute sore throat audit

• Acute sore throat audit [DOC] [XLS]  
• ASTA: Evaluation form [survey]

Acute otitis media audit

• Acute otitis media audit [DOC] [XLS]  
• AOMA: Evaluation form  [survey] 

Acute sinusitis audit

• Acute sinusitis audit [DOC] [XLS]  
• ASA: Evaluation form  [survey]

Acute cough audit

• Acute cough audit [DOC] [XLS] 
• ACA: Evaluation form  [survey]

UTI audit

• Uncomplicated UTI audit [DOC] [XLS]  
• UTI: Evaluation form  [survey]

Templates for accurate and easy auditing, including Read codes, current guidance and action plans.

Use these audit templates to assess your management of infection against current local and/or national guidelines. Audits toolkits are available for:

• UTI
• Acute sore throat
• Acute otitis media
• Acute otitis externa
• Acute cough
• Acute sinusitis
  

If you have any comments or feedback please contact us: TARGETantibiotics@phe.gov.uk 

Managing common infections guidance

Guidance produced by Public Health England in collaboration with the British Society for Antimicrobial Chemotherapy, the British Infection Society and the Royal College of General Practitioners for managing common infections for consultation and local adaptation. The guidance covers the appropriate use of antibiotics and antifungals and can be adapted locally, includes references and rationale and covers 

• Upper Respiratory Tract Infections
• Lower Respiratory Tract Infections
• Urinary Tract Infections
• Gastrointestinal Tract Infections
• Genital Tract Infection
• Meningitis
• Skin and Soft Tissue Infections 
• Eye Infections
• Dental Infections

Laboratory diagnosis and treatment guides

A series of quick reference guides for diagnosis of infectious disease including knowing when to use the microbiology laboratory and how to understand results. Quick reference guides are available for 

• Abnormal Vaginal Discharge
• Chlamydia Trachomatis 
• Fungal Skin and Nail Infections 
• Infectious Diarrhoea 
• Helicobacter Pylori in Dyspepsia 
• Urinary Tract Infection
• Venous Leg Ulcers

Checklist to measure your current antibiotic prescribing practice against others in your region and nationally

This tool is a short questionnaire for use by GP practices and Commissioning groups to assess antibiotic prescribing. Once you have completed this questionnaire you will be able to compare your results to other practices in your area, and nationally. Go to the information icons to find suggestion on what you can do to achieve each point.

• To begin: go here and select whether you are a GP or CCG representative
• Printable self assessment checklist for practice meetings or audits for all prescribers including GPs 
• Printable self assessment checklist for practice meetings or audits for commissioners

The following FREE training resources aim to provide up to date information and an evidence base to support optimal antibiotic prescribing. They will also help prescribers to help meet CPD and revalidation requirements. 

TARGET training resources

TARGET Antibiotic Webinar Series

This series of 7 TARGETantibiotics webinars, now available as un-facilitated learning courses, highlights simple key actions to help improve your antibiotic prescribing whilst improving the patient experience and their self-care, therefore freeing up your time.  

TARGET “why and how to achieve optimal prescribing” group training presentation

This presentation aims to provide up to date evidence for primary care clinicians about why optimising antibiotic prescribing is important and how this can be achieved. The presentation is designed to be delivered by GPs, microbiologists or medicine managers with an interest in antibiotic use however can be used by less experienced presenters.

• TARGET presentation introduction document details how the presentation has been designed and should be adapted to suit your training needs.
• TARGET antibiotic presentation core slides lasts 60 minutes and includes slide notes and references. Additional clinical scenarios and reference slides are available in the links below.
• Additional clinical scenario slides including sore throat, otitis media, skin infection and acute rhinosinusitis. 
• TARGET group presentation self-assessment and evaluation form  

TARGET Antibiotic Resistance in Primary Care eModule

This course will equip you with tools for improving your antibiotic prescribing and assist you in identifying the need for optimised antibiotic prescribing. Evidence showing the link between prescribing and resistance rates in GP patients is explored. 

RCGP learning e-modules

• Skin Infections eModule describes common presentations of bacterial, viral and fungal skin infections and outlines their management.
• Managing Acute Respiratory Tract Infections (MARTI) eModule will enable you to improve the care you provide to patients presenting with acute ear pain, acute sore throat, sinusitis and acute cough.
• Managing Urinary Tract Infections (MUTS) eModule explains the importance and appropriateness of diagnostics and offers advice on how to assess and treat patients with a range of urinary symptoms.
• Managing Infectious Diarrhoea eModule uses case studies to illustrate the clinical management of patients with infectious diarrhoea. The wider differential diagnosis of diarrhoea is also discussed.
• Sexual Health in Primary Care eModule highlights the importance of pro-active primary healthcare professionals, clinical and non-clinical, to improve the UK’s sexual and reproductive health needs. It includes normalising testing for STIs and overcoming barriers to discussing sexual health. 

Other useful training (not developed by TARGET)

• STAR: Stemming the Tide of Antibiotic Resistance: Developed buy Cardiff University, this eModule  focuses on antibiotic resistance (and its link with practice prescribing) and practical techniques for improving consultations for common infections.  
• Antimicrobial Stewardship: Managing Antibiotic Resistance, developed by BSAC and the University of Dundee. Understand antibiotic resistance, and how antimicrobial stewardship can slow down or reduce it, with this free online course.

Health Education England 

• Reducing Antimicrobial Resistance developed to support all health and social care staff understands the threats posed by antimicrobial resistance and ways they can help to tackle it. 

NICE/BMJ learning

NICE has developed a series of FREE open access online education tools in collaboration with BMJ Learning. The toolkit also supports the recommendations made in the NICE Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use guidelines, published August 2015. It also supports the Antimicrobial stewardship NICE quality standard, published April 2016.

• Feverish illness in young children  
• Feverish illness in young children: a guide for paediatric practitioners 
• Meningococcal disease in children: diagnosis and management in primary care 
• Sexually transmitted infections and under 18 conceptions 
• Tuberculosis 
• Urinary tract infection in children: diagnosis, treatment, and long term management
• Antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures

• Fingertips Public Health England AMR local indicators provide CCG and practice level data to enable action planning.
• PrescQIPP is an NHS funded not-for-profit organisation, produce evidence-based resources and tools for primary care commissioners, and provide a platform to share innovation across the NHS. 
• OpenPrescribing makes it easier for GPs, managers and everyone to explore NHS data.
• ePACT/ePact2 is an application which allows authorised users to electronically access prescription data, allowing access to real time online analysis of the previous sixty months prescribing data held on NHS Prescription Services' prescribing database.

Here are a series of resource documents to aid commissioners with the implementation of the TARGET resources.

Guidance for commissioners and stakeholders

This resource guidance contains detailed information about the background to the TARGET resources and how they can be used in primary care. It is intended as a guide for commissioners and stakeholders to use when implementing the TARGET resources in their region.

Trainers and commissioners background presentation

The presentation helps to explain to trainers how to roll out your local plan 

Self assessment checklist 

The self assessment checklist helps to measure your current antibiotic prescribing practice against others in your region and nationally. 

TARGET antibiotics workshop - group training

This modifiable 60 min presentation includes slide notes and references. It can be used as the basis of a group workshop which can be delivered by anyone with an interest in antibiotic prescribing (e.g. GPs, medicine managers or microbiologists).

The presentation covers information and tools that help influence social norms around antibiotic prescribing, clinicians' and patients' personal attitudes to antibiotic resistance, and suggests ways of decreasing barriers to appropriate antibiotic prescribing, with action planning.

We suggest that to maximise its effectiveness 

• all primary care staff in the practice or out of hours setting are invited 
• Practice antibiotic prescribing data are available and discussed
• The resources on the website are readily available to display
• The presenter is familiar with the local antibiotic guidance
• There is enough time for action planning 

• TARGET antibiotics workshop - Introduction
• TARGET antibiotics workshop - presentation template and additional clinical scenarios
• TARGET antibiotics workshop - evaluation form

Why use the TARGET antibiotics toolkit

Read an article about the TARGET toolkit in Commissioners Journal

• Commissioners Journal

• Antibiotic Guardian - The Antibiotic Guardian campaign encourages the general public and health professionals to pledge to use antibiotics more responsibly.
• Bristol University resources on caring for children with coughs - This website was created by a collaboration of researchers and parents who talked to lots of parents about what information they wanted to know when their child had a cough.
• The British Infection Association (BIA) - The BIA aims to promote the science and practice of medicine in relation to infection, to support all infection specialists and trainees, and to further research into infection.
• The British Society for Antimicrobial Chemotherapy (BSAC) - BSAC exists to facilitate the acquisition and dissemination of knowledge in the field of antimicrobial chemotherapy. 
• e-Bug - operated by Public Health England, is a free microbiology, hygiene and antibiotic educational resource for junior (9-11 years) and senior (12-15 years) school students, young adults (15-18 years) and community groups across Europe. 
• European Centre for Disease Prevention and Control (ECDC) - A number of initiatives are taking place across Europe to spread the messages on the risks associated with inappropriate use of antibiotics and how to take antibiotics responsibly.
• Health Education England (HEE) Antimicrobial Resistance -  The HEE antimicrobial resistance animation intends to assist prescribers when they are faced with somebody who incorrectly feels they should be prescribed an antibiotic. 
• Medicines for Children - The Medicines for Children website provides information for parents and carers about giving medicines to children, written and reviewed by doctors, pharmacists, parents and carers.
• Patient.info - This website has useful patient information leaflets about all minor illnesses and self management options.
• RCGP Sepsis Toolkit - The Sepsis toolkit provides a collection of tools, knowledge, and current guidance to support the identifying and appropriate management of patients with sepsis. 
• Scottish Antimicrobial Prescribing Group (SAPG) - SAPG is a national clinical multi-disciplinary forum and its primary objective is to co-ordinate and deliver a national framework for antimicrobial stewardship to enhance the quality of antimicrobial prescribing and management in Scotland. 
• Treat yourself better - The treat yourself better website has a symptom checker for cold and flu as well as the message that antibiotics do not work these symptoms.
• World Antibiotic Awareness Week (WAAW) and European Antibiotic Awareness Day (EAAD) - WAAW/EAAD  takes place during November each year and aims to increase awareness of global antibiotic resistance and to encourage best practices among the general public, health workers and policy makers to avoid the further emergence and spread of antibiotic resistance.