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Antimicrobial stewardship program 2016
The document discusses the role and goals of the Antimicrobial Stewardship Program (ASP) at Sir Charles Gairdner Hospital. The ASP aims to balance appropriate antibiotic treatment of patients with avoiding the selection of antibiotic resistant organisms. It does this by optimizing antibiotic therapy, improving patient outcomes, minimizing adverse effects, decreasing antibiotic resistance, and reducing costs. The program was implemented in 2010 and utilizes ward rounds and an antibiotic approval process to review patients' antibiotic use and provide recommendations for improved treatment. Data shows that after implementing the ASP, antibiotic usage at the hospital significantly decreased.
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Antimicrobial stewardship program 2016
- 1. Antimicrobial Stewardship Program at SCGH Jason Seet ID/CriticalCare Pharmacist Sir Charles Gairdner Hospital
- 2. Background All drugshave adverse effects Antibiotics have an ‘additional effect’ Known as ‘collateral damage’ Refers to the impact of the antibiotic on the colonising bacterial flora Selection of antibiotic resistant microorganisms Patient becomes colonised with resistant organisms
- 3. The dilemma... Antibioticsare one of the most important discoveries in modern medicine.. However, inappropriate use of antimicrobials may lead to ‘collateral damage’ On the other hand.. Severe restriction of antibiotics (inadequate therapy) in seriously ill patients is associated with increased mortality
- 4. ??.. Solution The roleof the Antibiotic Stewardship Program is to strike a balance between appropriately treating the patient and avoiding the selection of antibiotic resistant organisms
- 5. Role of antimicrobial stewardshipprograms (ASP) Aim to Optimise antimicrobial therapy (PRIORITY) Improve overall patient outcome Minimise adverse events Decrease the risk of development of antimicrobial resistance Reduce treatment related costs
- 6. How is thisachieved? To optimise therapy Improve selection/choice of antimicrobial – refer to microorganism, susceptibilities, resistance patterns, antibiotic spectrum Duration (eg: t1/2), overall therapy duration Dose – site of infection, drug factors (Vd, Cl, bioavailability) Route of administration (IV vs po)
- 7. How is thisachieved? Reduce antimicrobial costs Limit overuse Narrow spectrum chosen (avoid inappropriate use) Promote active IV to po switch Reduce hospital length of stay (minimising infections due to resistant organisms) Minimise adverse events TDM Dosage adjustments (individualise therapy)
- 8. NAUSP 2006-2009 data Datademonstrating total antibiotic usage amongst hospitals in Australia
- 9. How did SCGHfare in 2009…? Cefepime Clindamycin Ciprofloxacin Azithromycin Meropenem Timentin/Tazocin Augmentin DF The podium of shame
- 10. Outcome of thishigh usage.. Implementation of an Antimicrobial Stewardship Program (February 2010) HAPI (Healthy Antimicrobial Prescribing Initiative) ‘ward-side’ review of restricted antimicrobial therapy Written recommendations documented in notes
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- 12. HAPI rounds Consists of IDPharmacist ID Physician/Clinical Microbiologist +/- ID Registrar +/- Microbiology Registrar Review of patients on Restricted antimicrobials Prolonged course/s of antimicrobials
- 13. HAPI rounds The teamwill provide advice to the treating team in regards to most appropriate antimicrobial therapy Eg Cessation of therapy Change in therapy Narrow therapy Broaden therapy Switch to oral de-escalation Referral for ID consult
- 14. Why we needAMS? Broad spectrum antimicrobials commenced Appropriate therapy initially Micro results return Pathogen identified Susceptibility results available Patient improves.. But still on broad spectrum antimicrobials Infection resolved. Patient still on broad spectrum antimicrobials Patient ready for discharge Broad spectrum IV antimicrobials changed to broad spectrum oral antimicrobials
- 15. Impact of AMSrounds SCGH
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- 17. HAPI rounds 4x week rounds on general wards 2 x week rounds in ICU and GHDU 1 weekly round with Haematology team Soon.. eReferral option to AMS (HAPI team) for assistance with antimicrobial choices, de- escalation of therapy etc
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- 20. How can Ifind out more info? http://chips.qe2.health.wa.gov.au/projects/HAPI/index.html
- 21. Contact your clinical pharmacist Linkavailable via DFS http://dfsprod.hdwa.health.wa.gov.au/LoginPage.aspx
- 22. What can YOUdo? Overuse/abuse of antimicrobials affects everyone! How can you help? Request the prescribers to document antimicrobial indication on chart Antimicrobials warranted? Encourage the prescriber to request ID approval for restricted antimicrobials Question antimicrobial duration/s Encourage IV to oral switch Refer patients on prolonged antimicrobials to the HAPI team or your clinical pharmacist