9 Strategies to Promote Responsible Veterinary Antibiotic Use in Your Practice
There were nearly 67,000 serious antimicrobial-resistant infections in the UK in 2023, meaning antibiotic resistance isn’t just a scary futuristic scenario but is already happening. We all know that responsible veterinary antibiotic use is essential to minimise the spread of antimicrobial resistance (AMR), but how can you make sure the whole practice is on board?
We aren’t going to go into too much detail about responsible prescribing policies – plenty of organisations including the BSAVA, WSAVA, and BVA have published important guidelines to help vets with this. What we’re going to go into is how to manage your veterinary practice team to make sure antibiotics are used properly.
What does responsible veterinary antibiotic use look like?
Nobody is saying vets can’t use antibiotics – yet! But we do need to start reducing our use, including saving the ‘High Priority – Critically Important Antibiotics’ (HP-CIAs) for human use wherever possible. This means individual clinicians should be:
- Considering carefully before prescribing antibiotics
- Determining whether a non-antibiotic treatment is suitable
- Using culture and sensitivity testing to choose the best antibiotic for the job
- Choosing narrow-spectrum antibiotics
- Opitimising dosing (shorter courses, without underdosing)
But what about on a team level? Whether you are your practice’s designated ‘Antibiotic Steward’ or an ‘Antibiotic Guardian’, you’re prepping for Practice Standards Scheme visits, or you’re just very interested in AMR, let’s look at the ways you can improve your practice’s responsible use of antibiotics.
9 strategies for improving your practice’s responsible veterinary antibiotic use
1. Run an audit
The first step is to find out where you’re at. This is very important, because if you don’t know what’s happening, you can’t fix it. Instead of trying to audit everything, pick one area you think prescribing is high. You could use your Practice Management System (PMS) to find high sales of critically important antibiotics, or just choose a likely candidate for over-prescribing – dentals, acute diarrhoea, cat bite abscesses, urinary tract infections, otitis externa or kennel cough are all common in small animal practice.
To help with this, the RCVS is developing an antibiotic audit tool, or you can use the clinical audit template they have here.
P.S don’t forget an audit like this counts as CPD for vets or RVNs, so set your timer and log the hours!
2. Talk to your team
You’ll also want to get your team onboard. A 2022 study showed how effective a team intervention can be, with prescribing rates of cefovecin (a critically important antibiotic) dropping in cats by 27%, and vets opting for amoxycillin-clavulanate instead. A similar thing happened with metronidazole in dogs, although overall prescription rates were higher post-intervention than predicted.
Start by talking to everyone, from vet to receptionist. This could be a team meeting or you might want to speak to everyone in dribs and drabs – this can be a good way to casually bring up a clincian’s over-reliance on antibiotics in a way that doesn’t embarrass them. Ideally, you’ll have your audit results in hand, but even if an audit is too difficult to do right now, it’s worth making your team aware of what you’re planning and setting some goals. You could work as a team to fill out the BSAVA Protect ME poster, or choose one condition to focus on to reduce prescriptions. Once you’ve got some goals in place, set a time to check back in and see how it’s going.
3. Make sure client materials are available
We’ve all felt that pressure to prescribe something because the client says it’s ‘what worked last time’, or because we feel they need to go home with something in their hands in order to be satisfied, or even just to cover our backs to avoid deterioration and a complaint. In fact, one study of vets in Australia showed these were the biggest drivers of antibiotic use where they aren’t indicated. That’s where client materials explaining the responsible use of veterinary antibiotics are invaluable.
You could use the BSAVA ‘No Antibiotic Prescription Required’ form for when an antibiotic isn’t needed, or put together your own leaflet about the side-effects of overusing antibiotics where they aren’t indicated. Making clients aware of your goals in advance of them wanting a prescription will reduce the battle on the day. You might also want to ensure your waiting room TV has antibiotic information (there’s a free video here), put up posters in the waiting room, add your goals to your newsletter, or set up a client information evening to explain the recommendations and changes you’re making as a team. Including clients like this can help them feel empowered and like partners in their pet’s care, increasing bonding to the practice.
4. Make sure practice policies are easily available for visiting locums and peripatetic staff
It’s all very well having a staff meeting to get everyone on board, but if visiting vets aren’t following the same policies it can cause confusion and even rifts with clients. Make sure any antibiotic prescribing policies you put in place are explained in any onboarding materials, and display the BSAVA Protect ME poster somewhere it’s easily visible.
5. Set up your Practice Management System (PMS) to prompt
One excellent tactic to make sure everyone keeps to the new rules about responsible prescribing of veterinary antibiotics is to set up prompts and reminders on your PMS. You could set it up so it flashes up an ‘are you sure?’ message for critically important (category B) antibiotics. Or, so it asks for specific clinical details to be written in the history before an antibiotic can be dispensed, encouraging team members to share their reasoning. Or, so it suggests a ‘just in case’ prescription the client can phone back for if symptoms worsen, rather than something you dispense immediately. This is termed ‘delayed prescribing’, and in human medicine can result in over 60% of prescriptions not being used.
Most veterinary practice management software allows you to set prompts and reminders – if you’re struggling, call your provider’s customer support for advice.
6. Improve access to culture and sensitivity testing
Ideally, we wouldn’t ever prescribe antibiotics without a culture and sensitivity test guiding us. But how easy, and fast, can your vets get results? And is the cost off-putting to clients, meaning that it’s not regularly opted for? Consider looking at the markup on this sort of test, to see if it’s possible to reduce the cost to the client and make it easier for vets to do. Or look at investing in in-house options for simple conditions – options in the UK include the Virbac SPEED Biogram and the Flexicult Vet agar plate. Alternatively, if you’re a reasonably sized hospital or branch, you could invest in an incubator, agar plates, and antibiotic discs to perform in-house sensitivity testing, which is a lot simpler than it sounds. By doing this, costs can be significantly reduced and samples can be processed faster, making it easier for vets to do the test and prescribe veterinary antibiotics responsibly.
7. Encourage return of unused antibiotics
Improper disposal of antibiotics down the toilet, into composting systems, or even into landfill can encourage the spread of antibiotic resistance. Make sure clients are aware that they can (and should!) return unused medications to you for proper disposal. Posters on reception, a new label on all dispensed antibiotics, or a ‘how to use your pet’s antibiotics safely’ factsheet can all help.
8. Get current with an internal medicine certificate
One of the best ways to reduce your team’s use of antibiotics is with superior knowledge. But keeping abreast of the changing recommendations is tough for any busy vet. Could someone in your team do an internal medicine certificate? Not only will this update give them a new perspective on all things small animal medicine, but it’ll teach them the critical reasoning skills and evidence-based medicine techniques to help them keep abreast of future changes. Make sure the rest of the team then follow their lead, whether that’s ditching the metronidazole for acute diarrhoea or switching to a better intra-operative antibiotic protocol. Having a certificate holder on a veterinary team also makes it easier for the rest of the vets to resist client demands – internal referral for a second opinion can make clients feel more confident that antibiotics are not indicated.
9. Reward change
It’s a team effort to reduce antibiotic use, but there are often one or two clear leaders. Consider rewarding people for their efforts, whether it’s a shout out on your social media accounts, a bar of chocolate, or a small bonus. You could reward those who put their head above the parapet to encourage others to prescribe veterinary antibiotics responsibly, or you could reward those who meet their prescribing goals. Whatever it is, rewarding individuals can really motivate a whole team.
Conclusion
As veterinary professionals, we’re pretty good at understanding the need for responsible veterinary antibiotic use, but actually managing reduced prescriptions can be a lot harder. Fears over pet deterioration, client attitudes, and a client’s ability to detect deterioration mean vets still prescribe antibiotics where they aren’t indicated. With a team attitude, some new client materials, and some PMS prompts, teams can make strides in using veterinary antibiotics responsibly. And, of course, CPD (especially a small animal medicine certificate or a dermatology certificate) can give vets the skills and knowledge they need to be confident in their prescribing decisions.
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