Antimicrobial Stewardship - A/Prof Bhavini Patel & Emily Waddell & Dr Aathi Selvanayagam

1. Associate Professor Bhavini Patel - Adv.Prac.Pharm. GAICD
Executive Director Medicines Management
NACCHO conference – Darwin 2019
Department of Health
Antimicrobial Stewardship (AMS)
in Primary Health Care (PHC) settings

2. Acknowledgment to country
Dalirrgang – hot build up
Mangroves and magpie geese

3. Learning Outcomes
• Describe the drivers for high rates of antimicrobial use in Aboriginal
Communities
• Identify the key elements of an Antimicrobial Stewardship Program
• Describe the role of a pharmacist in an Antimicrobial Stewardship
Program
• Identify actions that need to be taken in your service to establish an
Antimicrobial Stewardship Program

4. • Increasing resistance of bacteria to
antibiotics is well documented as a
major healthcare issue
• The high burden of infectious
diseases in remote communities
results in high levels of antimicrobial
use
• Information on prescribing and
understanding of dynamic trends in
resistance in PHC setting is limited
Background
Governance of Aboriginal Health
Organisations
ACCHO Gov non-Gov
296
organisations

5. Strategies for effective use of antimicrobials
broad public health initiatives developed in
collaboration with each community
• Appropriate housing
• Adequate and safe supply of water and
nutrition
• Access to reliable electricity
• Sewerage and drainage
• Rubbish collection
Impact of Social determinants

6. What is Antimicrobial
Stewardship?

7. What is an AMS program?
• Promotes the use of the right antimicrobial, at the right dose,
for the right duration, at the right time by the right route
• Requires a systems based approach that operates with
support of the organisation using the expertise and the of a
multi-disciplinary team
https://www.safetyandquality.gov.au/resource-library/antimicrobial-stewardship-australian-health-care-2018
https://www.safetyandquality.gov.au/publications-and-resources/resource-library/antimicrobial-stewardship-clinical-care-
standard

8. Benefits of AMS program
 Reduction in unnecessary use of antimicrobials
 Reduction in antimicrobial resistance
 Improved clinical outcomes
 Improved patient safety
 Increased cost effectiveness
Need to monitor for unintended consequences
• Increase in acute kidney injury when switching from
cefuroxime to flucloxacillin for surgical prophylaxis for
orthopaedic surgery

9. Elements of an AMS program
Use of
evidence
based
guidelines
Involvement
of clinicians
to localise
implementation
Formulary of
restrictions
with approval
processes
Point of
care
testing
Use of
Care
Bundles
Timely
review of
prescriptions
by MDT

10. Understanding
Antimicrobial Use

11. Adapt and apply the National
Antibiotic Prescribing Survey (NAPS),
to the setting of Aboriginal Medical
Services in FNQ, NT, Kimberley
• The Peter Doherty Institute for Infection
and Immunity
• Top End Health Service
• Kimberley Aboriginal Medical Service
• Telethon Kids Institute
• Queensland Health
Understanding Antimicrobial Use

12. • Mix of doctors and remote area nurses
• Limited Aboriginal health practitioner
Antimicrobials for:
• Skin and soft tissue
• Lower respiratory tract
• Gastrointestinal
• Sexually transmitted infections
• Very little point of care testing
Results
WA NT QLD

13. Comparison with PBS
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
Top 10 Antimicrobial Use via PBS 2013Top 14 antimicrobial used in remote health centres 2018

14. ~80% of Antimicrobial use was
appropriate
Inappropriate use related to
• dosing and duration
rather than antimicrobial
choice
• where antimicrobial was
not required
Appropriateness

15. Role of the pharmacist - Panel Discussion
Ms Emily Waddell
Dr Aathi Selvanayagam
Associate Professor Bhavini Patel

16. Leadership
• Assessing readiness of organisation
• Developing and maintaining local
formulary and guidelines
• Developing and implementing coms
plan
Expert advice
• Prescription review and other point of
care services
• Patient and staff education
• Reviewing local data and trends
Role of pharmacist
Use of
evidence
based
guidelines
Involvement
of clinicians
to localise
implementation
Formulary of
restrictions
with
approval
processes
Point of
care
services
Use of
Care
Bundles
Timely
review of
prescriptions
by MDT