Rohana Hassan

Pharmacist U54

Head of Clinical Section

Pharmacy Department

Hospital Kuala Lumpur

Rohana Hassan

Pharmacist U54

Head of Clinical Section

Pharmacy Department

Hospital Kuala Lumpur

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MAIN BLOCK

MATERNITY HOSPITAL

HKL

PAEDIATRIC INSTITUTE

SPECIALIST CLINIC & AMBULATORY CARE CENTER (SCACC)

Introduction – What is Communicable Disease ( CD ) ?

Pharmacist & CDs

ASHP Statement on the Pharmacist’s Role in Antimicrobial Stewardship and Infection Prevention and Control

Pharmacists’ role in preventing antimicrobial resistance

Expanding role of antimicrobial pharmacist

SIDP-ACCP Joint opinion Paper

OUTLINE

Medical :

an infectious disease transmissible (as from person to person) by direct contact with an affected individual or the individual's discharges or by indirect means (as by a vector)—compare contagious disease

www.cdc.org

an illness caused by an infectious agent or its toxins that occurs through the direct or indirect transmission of the infectious agent or its products from an infected individual or via an animal, vector or the inanimate environment to a susceptible animal or human host.

The American Heritage® New Dictionary of Cultural Literacy, Third Edition

Any disease transmitted from one person or animal to another; also called contagious disease.

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FIN

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Basic Pharmacist Role :

Availability and cost-effective utilization

Medicine use evaluation

Appropriate safety

monitoring and reporting change

Continous Education

Promoting the rational, safe and effective use

of medicines

Pharmacists & CDs…

Programs to improve mx of HAIs and use of antimicrobial

drugs is ANTIMICROBIAL STEWARDSHIP

Patient characteristics, local antibiograms, dosing strategies to achieve optimal pharmacodynamic profile, early appropriate therapy can be utilised to improve clinical outcome, minimize

resistance development and reduce healthcare cost.

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WHAT IS Antimicrobial Stewardship ?An initiative to promote responsible use of antibiotic resources

Antimicrobial stewardship involves the optimal selection,dose and duration of an antibiotic resulting in the cure orprevention of infection with minimal unintendedconsequences to the patient including emergence ofresistance, adverse drug events, and cost.

Antimicrobial stewardship can play a key role in thereduction of infection

Implementing successful stewardship programs involvesmultiple strategies, administrative support, and effectivecollaboration of a multidisciplinary team

Antimicrobial Stewardship

Presented on 6/9/10 to US Congress

www.idsociety.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=16656

pharmacists responsible to take prominent roles inantimicrobial stewardship programs and participate in theinfection prevention and control programs of health systems.

ASHP believes that the pharmacist’s ability to effectivelyparticipate in antimicrobial stewardship and infectionprevention and control efforts can be realized through clinicalendeavours focused on proper antimicrobial utilization andmembership on multidisciplinary work groups andcommittees within the health system.

These efforts should contribute to the appropriate use ofantimicrobials, ultimately resulting in successful therapeuticoutcomes for patients with infectious diseases, and reduce therisk of infections for other patients and health care workers.

Where are we in managing CDs ?

Pharmacists’ responsibilities for antimicrobial stewardship and infection prevention and control include :

promoting the optimal use of antimicrobial agents

reducing the transmission of infections,

educating health professionals, patients, and public

Pharmacists Responsibilities

Encouraging multidisciplinary collaboration

Working within the pharmacy and therapeutics committee (or equivalent) structure, which may include infectious disease-related subcommittees, to ensure that the number and types of antimicrobial agents available are appropriate for the patient population

Operating a multidisciplinary, concurrent antimicrobial stewardship program that uses patient outcomes to assess the effectiveness of antimicrobial use policies

Promoting the optimal use of antimicrobial agents

Generating and analysing quantitative data on antimicrobial drug use to perform clinical and economic outcome analyses

Working with the microbiology laboratory personnel to ensure that appropriate microbial susceptibility tests are reported on individual patients in a timely manner, and collaborating with the laboratory, infectious diseases specialists

Utilizing information technology to enhance antimicrobial stewardship through surveillance, utilization and outcome reporting, and the development of clinical decision-support tools

Promoting the optimal use of antimicrobial agents

Participating in the infection prevention and control committee (or its equivalent).

Establishing internal pharmacy policies, procedures, and quality-control programs to prevent contamination of drug products prepared in or dispensed by the pharmacy department.

Promoting adherence to standard precautions by health care workers, patients, and others who impact the patient care environment

Reducing the Transmission of Infections.

Providing education and information about antimicrobial stewardship and infection prevention and control to health professionals, patients, and members of the public who come in contact with the health system’s practice settings.

Incorporating active intervention techniques, such as formulary restriction and preauthorization, enhances the effectiveness of educational activities in the patient care setting.

Educational Activities

Providing clinical conferences, newsletters, and other typesof educational forums for health professionals on topics suchas antimicrobial use and resistance, decontaminating agents(disinfectants, antiseptics, and sterilants)

Educating and counseling inpatients, ambulatory carepatients, home care patients, and their families andcaregivers in the following areas: adherence to prescribeddirections for antimicrobial use, storage and handling ofmedications and administration devices

Providing exposure to antimicrobial stewardship andinfection prevention and control practices

Educational Activities : Examples

education ofmedical,

pharmacy and nursing staff

audit of local practices

participation in infection control

antibiotic consumption

monitoring

formulary development

appraisal of new antimicrobials.

Key roles for antibiotic pharmacists

reducing medication

errors

reduce length of hospital stay

encouraging oral medication

ensuring appropriate drug choice

Benefits of dedicated Antibiotic Pharmacist :

…difficult to quantify exactly how great the clinical and financial benefits are as the studies in this field are generally of poor quality…

When I want to understand what is happening today or

try to decide what will happen tomorrow,

I look back.

Omar Khayyam

Potential shortcomings :

• The ability of an antibiotic pharmacist to be effective couldbe reduced by lack of other health care providers’knowledge or by lack of support from clinical colleagues.

• Pharmacy degree only provides basic training inmicrobiology, it is likely that further training such asResidency Programme, fellowship in practice, MSc ininfection management for pharmacists (UK) is crucial.

• Continuing training whilst in post and close liaison with aninfection specialist, to whom complicated cases can bereferred, also helps to develop diagnostic and evaluationskills that only come with experience.

Potential shortcomings :

• While many clinicians recognize the need to improveantimicrobial prescribing, not all will accept that their ownpractice may be in need of improvement….nobody likes to be toldwhat to use or what not to use !!

• The antimicrobial pharmacist need to work hard must workedvery hard to gain the respect of medical colleagues, some of whomwill not appreciate ‘interference’ from other health-care provider.

• Successful implementation of the antimicrobial pharmacist rolerequires good working relationships and trust to be developedwith clinical teams.

Potential shortcomings :

• It’s a great challenge for the pharmacist to show prove the benefitsof advice and collaboration with the clinical team rather than tobe reviewed as a policy enforcer or more focus on technical part,rather than clinical.

• Support and input from the clinical microbiologists will help to uplift the pharmacist profile …but pharmacist must work hard towards this.

• Moreover, agreement with the advice given, by the consultant in charge of the patient, is vital to give the pharmacist credibility with junior medical staff and will allow them to make greater contribution in the future.

(Pharmacotherapy 2009;29(4):482–488)

SIDP - Society of Infectious Diseases Pharmacists AmericanACCP - College of Clinical Pharmacy Infectious Diseases Practice and Research

Network

antimicrobial stewardship

programs recommend that a pharmacist with

infectious diseases training be included as a core member of

the antimicrobial stewardship team

self-directed learning or on-the-job

experiences in infectious diseases is

not considered feasible or sufficient for

reliable training of future clinical

specialists in infectious diseases

This document, therefore, is forward looking and provides

overarching recommendations for

future training and certification of

pharmacists practicing, mentoring, and

educating in infectious diseases

pharmacotherapy

Definition :

ID trained Pharrmacist ID clinical pharmacist

defined as a pharmacist who has received formalized training in infectious diseases pharmacotherapy

is one who practices in the collaborative care of patients with infectious diseases.

ID Clinical Pharmacist Responsibility

Clinical Service Research Educational

pharmacotherapy or pharmacokinetic evaluations,

therapeutic monitoring drug information or

patient education regarding antimicrobial therapy

antimicrobial stewardship participation or coordination

in vivo or in vitro antimicrobial assessments,

pharmacokinetic or pharmacodynamicanalyses,

resistance surveillance, pharmacoyeconomicanalyses

directed at patients, trainees, students, health care workers

Core Competency

Apply Quality Improvement

measures

Provide patient centered care

Work on inter –disciplinary

team

Employ evidence based

practice

Core Competencies for all health care professionals

Greiner AC, Knebel E, eds. Health professions education: a bridge to quality. Washington, DC: National Academy Press, 2003.

Make empiric, prophylactic, and definitive

antimicrobial treatment recommendations based

on patient-specific factors

Interpret and make treatment recommendations based on microbiology reports

Interpret and make treatment or formulary recommendations based on antibiogram or microbiology data

Critically evaluate and apply infectious diseases literature and research

Expanded competencies for infectious diseases–trained clinical pharmacists

Make informed, evidence-based, cost effective

recommendations to relevant parties regarding

formulary decisions

Participate in infectious diseases–related continuing professional development

Educate other health professionals (e.g., hospital staff, other pharmacists, students, and residents) and the public regarding infectious diseases

Design, implement, and monitor programs to prevent, delay, or combat antimicrobial resistance

Expanded competencies for infectious diseases–trained clinical pharmacists

To translate and transform all the recommendations / suggested / listed ROLES

& EXPANDED ROLES of pharmacist into practice….

It is not the strongest of the

species that survive, nor the

most intelligent, but the one

most responsive to change.

- Charles Darwin