Quality improvement project across Devon and Cornwall demonstrates sustained reductions in antibiotic prescribing and promotes evidence-based patient care

A team of veterinary professionals from CVS Vets has delivered significant improvements in antimicrobial stewardship after a large-scale quality improvement project spanning 15 veterinary sites across Devon and Cornwall.

The initiative, Audit for Action: Shaping Responsible Antibiotic Use in Nine Small Animal Practices in Devon & Cornwall, brought together veterinary surgeons, registered veterinary nurses and support colleagues from practices serving communities including Barnstaple, Newton Abbot, Truro, Newquay and Falmouth.

Led by a network of regional CVS Quality Improvement (QI) Leads, the project aimed to reduce prescribing of higher-priority antibiotics, decrease use of antibiotic-containing triple therapy ear medications, and support more diagnostic-led decision making through greater use of cytology and culture.

Over three audit cycles between November 2024 and July 2025, the team reviewed antimicrobial prescribing in non-routine consultations across nine practices. More than 2,100 consultations were analysed, enabling teams to benchmark prescribing patterns, identify opportunities for improvement and embed evidence-based antimicrobial stewardship principles into daily practice.

The results demonstrated a substantial and sustained improvement. Overall antibiotic prescribing fell from more than 32% of non-routine consultations at baseline to around 21% following intervention, while prescribing of Category B and Category C antimicrobials reduced and use of first-line Category D antibiotics increased. Prescribing of triple therapy ear medications also decreased substantially, with low levels of metronidazole use maintained throughout the project.

Key interventions included in-practice cytology and dermatology training, use of BSAVA PROTECT ME resources, regular clinical discussions, antibiotic stock reviews and changes to dispensary layouts that encouraged first-line prescribing choices. The team also focused on addressing the human factors that can influence prescribing decisions, including time pressures, workflow challenges, diagnostic confidence and access to equipment.

The success of the project has now been recognised nationally, with the CVS regional team for Devon and Cornwall receiving Highly Commended in the RCVS Knowledge Antimicrobial Stewardship and Quality Improvement Awards, highlighting the impact that collaborative, practice-led improvement initiatives can have on responsible antibiotic use across the profession.

Results have already been shared more widely through presentations at the London Vet Show and the Peninsula Antimicrobial Resistance Group (PARG), helping to disseminate learning beyond the participating practices and contribute to the wider conversation around antimicrobial resistance and One Health.

The team hopes the project will provide a practical, scalable model for other veterinary practices looking to strengthen antimicrobial stewardship, improve prescribing behaviours and support the long-term effectiveness of important antibiotic treatments.

Two audit cycles have been conducted during 2026 with another planned before the end of the year to build on the progress already achieved and identify additional opportunities for improvement.