March 24, 2021

Antimicrobial Stewardship

Heather Mackenzie is the Antimicrobial Stewardship (AMS) Pharmacist at Northern Hospital, and is responsible for making sure that we have a safe and robust antimicrobial stewardship program.

Antimicrobials is an umbrella term for antibiotics, antivirals, antifungals and antiparasitic medication.

The aim of this program is to promote the optimal usage of antimicrobials within the organisation, to make sure that we are giving the most appropriate treatment for patients, prescribing according to the guidelines, and providing tailored care to the individual.

“We do that in two ways, one aspect is individual patient review on the AMS ward rounds, and the other aspect is making sure we have all the systems and processes in place so that healthcare workers can use antimicrobials appropriately, such as developing guidelines and resources as well as delivering education and providing feedback based on our audit and surveillance work,” she explained.

“The ward rounds are aimed at protecting key antimicrobials, such as the broader spectrum intravenous agents, so that they are used only for the right infections and for the right duration. Myself and one of the infectious diseases consultants will review patients on these agents as identified by our Guidance approvals software, and provide recommendations to prescribers and pharmacists. We also use this as an opportunity to provide targeted education,” she said.

“In terms of the risk, if we don’t do this properly, we could face increased length of stay, and complications such as line infections, toxicity and developing resistance to antimicrobials, both in the individual and the community,” Heather explained.

Madelaine Flynn, Manager of the Infection Prevention and Surveillance service explained over the past few years, there has been an emerging resistance to Antimicrobials by some pathogens.

“Having a good Antimicrobial Stewardship program ensures patients safety and reduces transmission of infections in hospitals,” she said.

Infection prevention affects all departments, units, staff and every patient care interaction.

“It is very diverse – from looking at the environment, to looking how we are analysing risk associated with infections in healthcare and ensuring patients are not put at risk. The pandemic has put infection prevention in the spot light, and everyone is taking it more seriously, which includes things like hand hygiene and cough etiquette” she explained.

From an accreditation point of view, Madelaine advises we need to look at the environment, make sure everything is clean, things are being managed appropriately and  risk is escalated.

“Staff need to make sure we are doing our hand hygiene, as well as standard and transmission based precautions. Also, educating patients and their families about Infectious risk and risk associated with inappropriate antimicrobial use. We do things well here at Northern but there are things we could do better. I would like to encourage all staff in all areas and roles to look quality improvement activities associated with infection prevention and working with key stakeholders in your area to improve patient outcomes,” she explained.

From the Antimicrobial Stewardship point of view, Heather would like to encourage all staff involved in the use of antimicrobials, be it prescribing, administering, reviewing or supplying, to look at the Antimicrobial Stewardship procedure on PROMPT, to see what their roles and responsibilities are within AMS.

“It is everyone’s responsibility to advocate for patient safety,” both agree.