Infection prevention and control

Competency statement

All newly qualified pharmacists must understand the core knowledge underpinning infection prevention and control and use this knowledge appropriately to prevent the spread of infection by applying the principles of the national infection prevention and control manual.

Key themes:

• Micro-organisms
• Colonisation vs infection
• Infection transmission
• Screening
• Standard precautions
• PPE
• Healthcare associated infections
• IPC policies and procedures

• Describe the chain of infection and how this can be broken with different IPC interventions
• Describe the routes of transmission for infections and what precautions can prevent these.

• Use the correct hand washing technique for healthcare environments
• Use appropriate standard precautions when handling specimens e.g. urine for pregnancy testing
• Demonstrate the ability to handle sterile products in an aseptic manner
• Discuss the risk of C. difficile infection with a patient prescribed a broad-spectrum antibiotic
• Carry out an IPC risk assessment of their working environment, with reference to the national IPC manual for England, and escalate any concerns appropriately
• Conduct an IPC audit, intervention and re-audit using quality improvement methodology.

Antimicrobials and antimicrobial resistance

Competency statement

All newly qualified pharmacists need to understand the core knowledge underpinning the action of antibiotics and the concept of antimicrobial resistance; and use this knowledge to help prevent antimicrobial resistance.

Key themes:

• Classes of antimicrobials
• Spectrum of activity
• Broad vs narrow spectrum
• Intrinsic vs acquired resistance
• Consequences of resistance to population and individual
• One Health concept

• Describe the factors that contribute to emergence of resistance
• Describe why a One Health approach to AMR is important
• Describe how you would ask patients to dispose of any left-over antimicrobials e.g. liquid once they have completed the prescribed course.

• For 5 different antibiotic prescriptions, discuss
• the antibiotic class and spectrum of activity,
• what infection they are likely to be treating according to local antibiotic guidance (or national NICE guidance where local not available),
• whether this is first or second line on guidance and why second line antibiotics might be needed for this infection.
• Discuss resistance mechanisms for this antibiotic and resistance risk factors for this infection.

Antimicrobial prescribing and stewardship

Competency statement

All newly qualified pharmacists need to demonstrate knowledge of how infections are diagnosed and managed and use this knowledge appropriately to manage patients with infections including the appropriate use of antimicrobial agents.

Key themes:

• Appropriate use of antimicrobials
• Sepsis
• Clinical decision tools
• Diagnostic criteria
• Antimicrobial prescribing guidance national vs local
• Antimicrobial prescribing empirical vs targeted
• Antimicrobial prescribing and patient factors
• Antibiotic post-prescription review
• Antibiotic side effects
• Antibiotic interactions
• Antibiotic allergies
• PK-PD principles of antibiotics and TDM
• IV to oral switch
• Prescribing for surgical prophylaxis
• Prescribing for common infections.

• Be able to score an example case for NEWS2
• Be able to describe a clinical decision tool for antimicrobial prescribing and correctly use it in a case study of their design.
• Be able to describe the principles of therapeutic drug monitoring and identify 2 antibiotics that require TDM and why.
• Describe how to review a patient on antibiotics using the START SMART then focus algorithm and when it would be appropriate to choose each of the 5 post-prescription review decisions and where this should be documented.
• Discuss the difference between empirical and targeted antibiotic therapy, (based on microbiology results) explaining when each is preferred and why.
• Discuss the difference between prophylactic and treatment course of antimicrobials and when prophylaxis is needed.
• Describe the principle and significance of infection source control, providing an example.
• Access the National Antimicrobial Prescribing and Stewardship competency framework and discuss similarities and differences with the pharmacy undergraduate curricula.

• For 5 different antibiotic prescriptions identify and discuss possible interactions and side effects with patients and/or carers.
• For 5 different antibiotic prescriptions discuss with the patient/carer why it is important to take the antimicrobial as directed and complete the prescribed course.
• Discuss penicillin allergy with a patient/carer that has this documented to determine if this is an accurate diagnosis, if not discuss de-labelling with the patient’s doctor.

Vaccine uptake

Competency statement

All newly qualified pharmacists need to demonstrate knowledge of the importance of vaccines for reducing antimicrobial resistance and use this knowledge appropriately to promote vaccination.

Key themes:

• National and local immunisation programmes
• Clinical risk groups
• Staff vaccination requirements
• General principles of immunisation
• Risks and benefits of vaccination
• Controversies or misconceptions and how to ‘myth bust’
• Awareness of cultural sensitivities

• Explain the general principles of immunisation including the need for boosters and observing intervals between doses.
• Discuss national and local immunisation programmes and the diseases for which vaccines are currently available.

• Participate in the delivery of vaccine programmes including seasonal flu.
• Discuss the benefits and risks of appropriate vaccinations with patients in at least 3 different clinical risk groups.
• Promote a vaccination programme using national and /or local resources for staff or service users eg flu, COVID-19, zoster, MMR etc addressing misconceptions with an awareness of cultural sensitivity in that setting.

Person-centred care

Competency statement

All newly qualified pharmacists must seek out, integrate and value as a partner the input and engagement of the patient /carer in designing and implementing care.

Key themes:

• Shared care decision making
• Delayed antibiotic prescribing
• Safety netting advice
• Education and support using appropriate resources
• Counselling on antimicrobial use and antimicrobial resistance
• Public health campaigns
• Health inequalities

• Explain principle of delayed (back-up) prescribing and circumstances when this strategy can be considered.

• Discuss with at least 5 different patients self-care advice and safety netting for common infections including the use of appropriate patient leaflets (e.g. TARGET) and/or patient decision-making guides (e.g. NICE).
• Actively participate in promoting AMS messaging during World AMR Awareness Week and actively support sign up to Antibiotic Guardian pledge amongst patients and co-workers.
• Identify any inequity in access to infection management services or unmet need for patient educational materials for your local patient population showing how you have engaged with patients/public/stakeholders and public health information on health inequalities.

Interprofessional collaborative practice

Competency statement

All newly qualified pharmacists need to understand how different professions collaborate in relation to how they contribute to antimicrobial stewardship and quality improvement.

Key themes:

• Awareness of roles in different teams across systems
• Collaborative effective communication
• Trusting relationships
• Prescribing etiquette
• Governance
• Benchmarking
• Quality improvement
• National initiatives

• Outline the advantages of a multi-disciplinary team approach to management of infection
• Describe prescribing etiquette and how it impacts on AMS and patient safety.

• Actively contribute to national/local action plan in place to improve quality of care for patients with infection e.g. CQUIN, QOF, PQS, local incentive schemes
• Access AMS benchmarking data for your organisation or ICB and identify areas for improvement. ·         Undertake a Quality Improvement project in one of these areas for AMS with other healthcare professionals, patients and identified stakeholders including audit, intervention and re-audit.
• Attend local and system wide AMS meetings to feed back Quality Improvement project results.