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Antimicrobial stewardship program 2016

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Antimicrobial stewardship program 2016

  1. 1. Antimicrobial Stewardship Program at SCGH Jason Seet ID/Critical Care Pharmacist Sir Charles Gairdner Hospital
  2. 2. Background  All drugs have 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. 3. The dilemma...  Antibiotics are 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. 4. ??.. Solution The role of the Antibiotic Stewardship Program is to strike a balance between appropriately treating the patient and avoiding the selection of antibiotic resistant organisms
  5. 5. Role of antimicrobial stewardship programs (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. 6. How is this achieved? 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. 7. How is this achieved?  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. 8. NAUSP 2006-2009 data Data demonstrating total antibiotic usage amongst hospitals in Australia
  9. 9. How did SCGH fare in 2009…? Cefepime Clindamycin Ciprofloxacin Azithromycin Meropenem Timentin/Tazocin Augmentin DF The podium of shame
  10. 10. Outcome of this high 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
  11. 11. HAPI RoundAntimicrobial Committee Site-specific guidelines and antibiograms Electronic decision support
  12. 12. HAPI rounds Consists of ID Pharmacist ID Physician/Clinical Microbiologist +/- ID Registrar +/- Microbiology Registrar Review of patients on Restricted antimicrobials Prolonged course/s of antimicrobials
  13. 13. HAPI rounds The team will 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. 14. Why we need AMS? 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. 15. Impact of AMS rounds SCGH
  16. 16. Ongoing reduced usage SCGH
  17. 17. HAPI rounds  4 x 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
  18. 18. Can we relax…?
  19. 19. Can we relax…?
  20. 20. How can I find out more info? http://chips.qe2.health.wa.gov.au/projects/HAPI/index.html
  21. 21. Contact your clinical pharmacist Link available via DFS http://dfsprod.hdwa.health.wa.gov.au/LoginPage.aspx
  22. 22. What can YOU do?  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

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