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  • Journal article
    Reynolds M, Larsson E, Hewitt R, Garfield S, Franklin BDet al., 2015,

    Development and evaluation of a pocket card to support prescribing by junior doctors in an English hospital.

    , International Journal of Clinical Pharmacy, Vol: 37, Pages: 762-766, ISSN: 2210-7711

    Background Junior doctors do most inpatient prescribing, with a relatively high error rate, and locally had reported finding prescribing very stressful. Objective To develop an intervention to improve Foundation Year 1 (FY1) doctors' experience of prescribing, and evaluate their satisfaction with the intervention and perceptions of its impact. Methods Based on findings of a focus group and questionnaire, we developed a pocket Dose Reference Card ("Dr-Card") for use at the point of prescribing. This summarised common drugs and dosing schedules and was distributed to all new FY1 doctors in a London teaching trust. A post-intervention questionnaire explored satisfaction and perceived impact. Results Focus group participants (n = 12) described feeling anxious and time pressured when prescribing; a quick reference resource for commonly prescribed drug doses was suggested. Responses to the exploratory questionnaire reinforced these findings. Following Dr-Card distribution, the post-intervention questionnaire revealed that 29/38 (76 %) doctors were still using it 2 months after distribution and 38/38 (100 %) would recommend ongoing production. Conclusions FY1 doctors reported feeling stressed and time pressured when prescribing; this was perceived to contribute to error. A pocket card presenting common drugs and doses was well-received, perceived to be useful, and recommended for on-going use.
  • Journal article
    Gharbi M, Moore LSP, Gilchrist M, Thomas CP, Bamford K, Brannigan ET, Holmes AHet al., 2015,

    Forecasting carbapenem resistance from antimicrobial consumption surveillance: Lessons learnt from an OXA-48-producing Klebsiella pneumoniae outbreak in a West London renal unit

    , International Journal of Antimicrobial Agents, Vol: 46, Pages: 150-156, ISSN: 1872-7913

    This study aimed to forecast the incidence rate of carbapenem resistance and to assess the impact of an antimicrobial stewardship intervention using routine antimicrobial consumption surveillance data. Following an outbreak of OXA-48-producing Klebsiella pneumoniae (January 2008–April 2010) in a renal cohort in London, a forecasting ARIMA model was derived using meropenem consumption data [defined daily dose per 100 occupied bed-days (DDD/100 OBD)] from 2005–2014 as a predictor of the incidence rate of OXA-48-producing organisms (number of new cases/year/100,000 OBD). Interrupted times series assessed the impact of meropenem consumption restriction as part of the outbreak control. Meropenem consumption at lag −1 year (the preceding year), highly correlated with the incidence of OXA-48-producing organisms (r = 0.71; P = 0.005), was included as a predictor within the forecasting model. The number of cases/100,000 OBD for 2014–2015 was estimated to be 4.96 (95% CI 2.53–7.39). Analysis of meropenem consumption pre- and post-intervention demonstrated an increase of 7.12 DDD/100 OBD/year (95% CI 2.97–11.27; P < 0.001) in the 4 years preceding the intervention, but a decrease thereafter. The change in slope was −9.11 DDD/100 OBD/year (95% CI −13.82 to −4.39). Analysis of alternative antimicrobials showed a significant increase in amikacin consumption post-intervention from 0.54 to 3.41 DDD/100 OBD/year (slope +0.72, 95% CI 0.29–1.15; P = 0.01). Total antimicrobials significantly decreased from 176.21 to 126.24 DDD/100 OBD/year (P = 0.05). Surveillance of routinely collected antimicrobial consumption data may provide a key warning indicator to anticipate increased incidence of carbapenem-resistant organisms. Further validation using real-time data is needed.
  • Journal article
    Charani E, Gharbi M, Hickson M, Othman S, Alfituri A, Frost G, Holmes Aet al., 2015,

    Lack of weight recording in patients being administered narrow therapeutic index antibiotics: a prospective cross-sectional study

    , BMJ Open, Vol: 5, ISSN: 2044-6055

    Objectives Patient weight is a key measure for safe medication management and monitoring of patients. Here we report the recording of patient's body weight on admission in three hospitals in West London and its relationship with the prescription of antibiotic drugs where it is essential to have the body weight of the patient.Methods A prospective cross-sectional study was conducted in three teaching hospitals in West London. Data were collected during March 2011–September 2011 and July 2012–August 2012, from adult admissions units, medical and surgical wards. Data from each ward were collected on a single day to provide a point prevalence data on weight recording. Patient medication charts, nursing and medical notes were reviewed for evidence of weight and height recording together with all the medication prescribed for the patients. An observational study collecting data on the weight recording process was conducted on two randomly selected wards to add context to the data.Results Data were collected on 1012 patients. Weight was not recorded for 46% (474) of patients. Eighty-nine patients were prescribed a narrow therapeutic antibiotic, in 39% (35/89) of these weight was not recorded for the patient. Intravenous vancomycin was the most commonly prescribed antibiotic requiring therapeutic monitoring. In total 61 patients were receiving intravenous vancomycin and of these 44% (27/61) did not have their weight recorded. In the observational study, the most frequently identified barrier to weight not being recorded was interruptions to the admission process.Conclusions Despite the clinical importance of body weight measurement it is poorly recorded in hospitalised patients, due to interruptions to the workflow and heavy staff workloads. In antibiotics a correct, recent patient weight is required for accurate dosing and to keep drugs within the narrow therapeutic index, to ensure efficacy of prescribing and reduce toxicity.
  • Journal article
    Freeman R, Moore LSP, Charlett A, Donaldson H, Holmes AHet al., 2015,

    Exploring the epidemiology of carbapenem-resistant Gram-negative bacteria in west London and the utility of routinely collected hospital microbiology data

    , JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, Vol: 70, Pages: 1212-1218, ISSN: 0305-7453
  • Journal article
    Jones P, Moore LSP, Donaldson H, 2015,

    Evolution of antibiotic resistance in bacteria involved in urinary tract infections: A 3-year London experience

    , AMERICAN JOURNAL OF INFECTION CONTROL, Vol: 43, Pages: 419-420, ISSN: 0196-6553
  • Journal article
    Castro-Sanchez E, Holmes AH, 2015,

    Impact of organizations on healthcare-associated infections

    , JOURNAL OF HOSPITAL INFECTION, Vol: 89, Pages: 346-350, ISSN: 0195-6701
  • Journal article
    Drumright LN, Frost SD, Elliot AJ, Catchpole M, Pebody RG, Atkins M, Harrison J, Parker P, Holmes AHet al., 2015,

    Assessing the use of hospital staff influenza-like absence (ILA) for enhancing hospital preparedness and national surveillance

    , BMC INFECTIOUS DISEASES, Vol: 15, ISSN: 1471-2334
  • Journal article
    Holmes A, Castro-Sánchez E, Ahmad R, 2015,

    Guidelines in infection prevention: Current challenges and limitations

    , British Journal of Health Care Management, Vol: 21, Pages: 275-277, ISSN: 1358-0574
  • Journal article
    Moore LSP, Freeman R, Gilchrist MJ, Gharbi M, Brannigan ET, Donaldson H, Livermore DM, Holmes AHet al., 2014,

    Homogeneity of antimicrobial policy, yet heterogeneity of antimicrobial resistance: antimicrobial non-susceptibility among 108717 clinical isolates from primary, secondary and tertiary care patients in London.

    , Journal of Antimicrobial Chemotherapy, Vol: 69, Pages: 3409-3422, ISSN: 1460-2091

    Objectives We examined the 4 year trend in antimicrobial susceptibilities and prescribing across levels of care at two London teaching hospitals and their multisite renal unit, and for the surrounding community.Methods Laboratory and pharmacy information management systems were interrogated, with antimicrobial use and susceptibilities analysed between hospitals, within hospitals and over time.Results A total of 108 717 isolates from 71 687 patients were identified, with significant differences (at P < 0.05) in antimicrobial susceptibility between and within hospitals. Across the 4 years, rates of ESBL-/AmpC-producing Enterobacteriaceae ranged from 6.4% to 10.7% among community isolates, 17.8% to 26.9% at ward level and 25.2% to 52.5% in critical care. Significant variations were also demonstrated in glycopeptide-resistant enterococci (ward level 6.2%–17.4%; critical care 21.9%–56.3%), MRSA (ward level 18.5%–38.2%; critical care 12.5%–47.9%) and carbapenem-resistant Pseudomonas spp. (ward level 8.3%–16.9%; critical care 19.9%–53.7%). Few instances of persistently higher resistance were seen between the hospitals in equivalent cohorts, despite persistently higher antimicrobial use in Hospital 1 than Hospital 2. We found significant fluctuations in non-susceptibility year on year across the cohorts, but with few persistent trends.Conclusions The marked heterogeneity of antimicrobial susceptibilities between hospitals, within hospitals and over time demands detailed, standardized surveillance and appropriate benchmarking to identify possible drivers and effective interventions. Homogeneous antimicrobial policies are unlikely to continue to be suitable as individual hospitals join hospital networks, and policies should be tailored to local resistance rates, at least at the hospital level, and possibly with finer resolution, particularly for critical care.
  • Journal article
    King D, Jabbar A, Charani E, Bicknell C, Wu Z, Miller G, Gilchrist M, Vlaev I, Franklin BD, Darzi Aet al., 2014,

    Redesigning the 'choice architecture' of hospital prescription charts: a mixed methods study incorporating in situ simulation testing

    , BMJ OPEN, Vol: 4, ISSN: 2044-6055

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