The Big Fight Campaign

Professor Phillip Routledge
Rhys Howell
Debra Woolley
Janice Price
Christine Woods

Abertawe Bro Morgannwg University Health Board

Project Scope

The Big Fight campaign aims to improve patient outcomes and minimise the potential risks for increasing antibiotic resistance and C. difficile infection (CDi) through the development and implementation of a multidisciplinary programme through which the principles of prudent healthcare can be applied to improve antimicrobial stewardship in primary care.

Key stakeholders include:

Starting conditions

ABMU Health Board has, for a number of years had the highest antibiotic prescribing in Wales and one of the highest across England and Wales combined. Prescribing data also shows wide variation in the prescribing of antibacterials.

The Medicines Management team had implemented a variety of antimicrobial stewardship improvement interventions over several years with limited success which culminated in the successful case for a funded Big Fight Campaign with a dedicated team of staff which commenced in early 2016. The team includes an antimicrobial pharmacist, infection control nurse and data analyst.

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Analysis / Problem Solving Methods / Approach

The Big Fight team were able to access a variety of support through the Bevan Commission Exemplar programme. This support enabled the team to take a ‘fresh look’ at implementation of improved antimicrobial stewardship in the community and develop a programme of work.

Goals and Target

Future State

Recent prescribing data shows that Abertawe Bro Morgannwg University (ABMU) Health Board is reducing overall prescribing of antibacterials at a greater rate than the rest of Wales.

Antimicrobial prescribing is significantly affected by seasonal variation and so whilst initial results are promising it will be difficult to validate any improvement until after winter 2016/17 where antimicrobial prescribing traditionally reaches its highest levels.

Interventions / Actions

The Big Fight Team have progressed a number of priority actions to improve antimicrobial stewardship in the community. Two such examples are reported in separate pages (‘GP Practices’ and ‘Enhanced Antimicrobial Stewardship in Care Homes’).

Others include:

  1. Introduce non-clinical local Big Fight Campaign Managers in GP practices;
  2. Facilitate GP practice-based antimicrobial stewardship improvement plans, clinical audit and patient engagement activities;

Benefit / Impact / Outcome

The Big Fight team undertook a stakeholder engagement event in November 2016 – ‘The Big Event’ was multidisciplinary with over 100 attendees (including from GP practices, care homes and patient representatives), which generated a wealth of ideas around engagement.

Fit with Prudent Health

Part of Cohort Bevan Exemplar Projects 2015-16