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4. Action plan: Scottish Government Health Directorates ( SGHD)
The primary role for SGHD is to encourage and facilitate the detection and reporting of local and national trends in antimicrobial resistance and antimicrobial utilisation by allocating tasks and ensuring consistency and coherence with related health policy developments. The principal task in the context of the current document is to ensure the establishment of a national framework for the generation, collation, interpretation and dissemination of data from national agencies to NHSScotland, and to provide systems for the effective communication of relevant information and policies.
Antimicrobial resistance
It is noted and welcomed that, in order to provide better-validated and consistent information concerning antimicrobial resistance to prescribers, microbiologists, antimicrobial management teams ( AMT) and also for national surveillance programmes, the Scottish Government is funding purchase of standardised automated antimicrobial sensitivity testing equipment across all NHS Boards. This has been implemented as part of the HAI Task Force programme, and that body will continue to oversee and further develop the national strategic context for antimicrobial resistance.
Health Protection Scotland is tasked with collating, analysing and interpreting these surveillance data in order to help minimise the spread of antimicrobial resistance.
Antimicrobial Utilisation
The National Medicines Utilisation Unit ( NMUU) can currently collate data on antimicrobial usage for NHS 'out of hospital' care. There is at present no equivalent standardised information available for hospital services or private prescribers and suppliers (e.g. dentists); systems should be put in place as soon as possible to facilitate provision of this information. A Scottish prescription: Managing the use of medicines in hospitals, a report prepared by Audit Scotland 29, highlighted that data linking antimicrobial usage to diagnosis are also not available; again, new systems will be required to facilitate the provision of this information. It is appreciated that such systems may not be operational for some years, but work to provide them is urgently required if we are to address the problem of resistant infections in hospitals, and indeed many other issues surrounding prescribing habits in Scotland.
The Steering Group recommends that there is a need for SGHD to identify a national body to work closely with Health Protection Scotland and the National Medicines Utilisation Unit to collate and disseminate scientifically rigorous information on antimicrobial resistance trends and antimicrobial use on an ongoing regular basis to NHS Boards, their Antimicrobial Management Teams, national stakeholder organisations, and the Scottish Government. This should also encourage and promote investigation into variations in antimicrobial prescribing and microbial resistance patterns and thereby encourage the adoption of best practise across the country. The Steering Group has considered the possible bodies that could fulfil this function and recommends that the Scottish Medicines Consortium be tasked to undertake this additional function. Agreement in principle from Scottish Medicines Consortium has been obtained.
Education
Education of prescribers should be co-ordinated through NHS Education for Scotland as part of the ongoing suite of initiatives developed by them on behalf of the HAI Task Force. Consideration should also be given to, if or how appropriate methods of public education on antimicrobials can be facilitated.
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