Antimicrobial Stewardship Program: From the Philippines to Saudi Arabia
Published on: 30 November, 2018
Jeffrey Mendoza is a Filipino expatriate now based in Riyadh, Saudi Arabia. He recently completed the POLHN self-paced course, Antimicrobial Stewardship Programmes in Hospitals. As the final assignment for this course, Jeffy shared an exemplary piece about his experience what he has learned. It is our pleasure to share it on the POLHN Blog.
I am a Filipino expatriate who works in Saudi Arabia. I have worked in the Philippines but there is no antimicrobial stewardship program in that small hospital. And since it is a third world country, we lack resources. Currently, I am privileged to work in a 500 bed capacity tertiary hospital in Saudi Arabia with good supply of resources and manpower.
What is the most feasible AMS team composition to work effectively in your institutional context?
We have already formed an Antimicrobial Stewardship Committee, which is composed of an infectious disease consultant, a clinical pharmacist, infection control practitioner and nursing leader. We also have infectious disease consultants that are doing rounds every day. Our medical director is also our infection control director as well as the chairman of the therapeutics committee. He oversees the activities of the antimicrobial stewardship team. We have clinical pharmacist who monitors the use of antibiotics. Our pharmacists coordinate with the clinicians regarding prescription of antibiotics and preparation of it. All orders are in the system so there is easy communication in the orders. The infection control team formulated the antimicrobial stewardship policy based on guidelines. This policy is uploaded in the intranet and available for all staff for reference. Our microbiologist is active in reporting MDRO cases and sending antibiogram reports every 6 months. This antibiogram is the reference point for empirical treatment.
What are the challenges in establishing an AMS team?
Since it is a new hospital and there are a lot of changes, staffs come and go that is why there wasn’t a continuation of what has to be started in antimicrobial stewardship (AMS) programme. Then there was an assigned chairman of infectious disease physician who became the permanent head of the AMS team. The CEO is supportive of the AMS Programme. One of the challenges is that clinicians are not aware of such programmes especially in terms of antibiotic prescription. Another is on how to order the system, since there is automatically a 5 to 7 day regimen for antibiotics.
What are the strategies to overcome these challenges?
The first strategy is to hire competent ID physicians and consultants and formulate a committee and team for antimicrobial stewardship. Secondly, the team educated clinicians regarding the proper prescription of antibiotics. We have set restrictions on what antibiotics can be prescribed by residents, internal medicine and specialist like infectious disease consultants in order to regulate the dispensing of drugs. This is in coordination with the IT department. We are still facing issues with the ordering system, but we advised clinicians to monitor the antibiotic that the patients are receiving and there are infectious disease physicians who monitor the patients. At the same time we encourage the nurses to be vigilant and know if the antibiotics are appropriate based on culture and sensitivity
What is the way forward?
We are looking forward to having a more established AMS Committee. The Infection Control Department is planning to do surveillance for antimicrobial use and to compare with the Multi-Drug Resistant Organism (MDRO) surveillance. We are also looking forward to having a more systematic way of prescription of antibiotics using our electronic system. The Infection Control Department will work hand in hand with Antimicrobial Stewardship Committee.
Interested in learning more about advancing opportunities for antimicrobial stewardship at your workplace? POLHN’s course is free, self-paced and accredited; you will even receive an official certificate upon completion. Click here to learn more.