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AMS in inpatient general care

Video of Dr Mushira Enani interviewing Dr Alawdah about inpatient general care.
Hello, everyone. I’m Mushira Enani, adult infectious disease consultant. And today I’m very pleased to have with me Laila Alawdah. She’s a paediatric infectious disease consultant who has great experience in implementing stewardship in children. Hi, Laila. Hi, thank you so much for having me today. Can you share with us your experience implementing stewardship in children? What was the strategy you used? So in our Children’s Hospital at King Fahad Medical City, we implement multiple strategies for antimicrobial stewardship. We started with antimicrobial restriction, however, with time we realised that it’s not really effective. So we complemented that with the back end strategy with perspective audit and feedback. And trying to implement antibiotic timeout at the paediatric intensive care unit.
And during that 1 and a half year experience back in 2013, we were able to drop vancomycin, and tazocin, and meropenem use as we can see here. That’s great. So how much was the drop in utilisation? So for vancomycin, we went down from 350 days of therapy per 1,000 patient days, to about 250. And as you can see for piperacillin-tazobactam from 350 to 450. And we were also able to drop the meropenem as well. That’s really great. I’m sure you faced a lot of challenges, so can you tell us what challenges did you see? Well, first of all being a non-automated health electronic record, we had a big challenge in actually having reliable data to monitor antibiotic use.
We also had a challenge in sustainability because we were having limited resources, and we were not able to sustain this until we came up with other solutions. And also we came up into it with a challenge that some physician had issues with trust, so trusting our recommendation and actually going with our recommendation. OK, that sounds really challenging - I mean, great challenges. So how did you optimise or come up with solutions against these challenges? So for the antibiotic monitoring, we came up with that antibiotic tracking sheet, where physicians whenever the order any new medication, they would document the medication, the dose, the indication, and the plan time out timing.
And every 72 hours, any antibiotic that’s been prescribed and written in that sheet, should have a review date and monitoring for the culture results and the continuous indication and the plan duration. So that sheet was actually our tool to actually monitor the antibiotics. And we mandated that every antibiotic prescribed in the unit to be written in that sheet. And in terms of the sustainability, we realised that we can’t do everything ourselves, as an infectious disease specialist myself, and our clinical pharmacist. So we trying to mobilise available resources, so we actually involved the nursing in the unit. We had our infection prevention and control champion at the unit to actually help supervise the completeness of these forms.
And every patient that is admitted would have these sheets in the his files, and then also every patient before he gets discharged from the unit, make sure that these forms are complete. And because we had a big leadership support and sustainability– leadership support and actually reliability, accountability, we were meeting with the PICU team very frequently. And with that, we were showing them the data. And when we feedback the data, they gained our trust. And because when physicians see their seniors doing that, and there is not much effect on the mortality, they were more– So they were engaged more. Exactly. Thank you very much. That’s a great experience. Thank you.

In this video, Dr Mushira Enani talks to Lailah Alawdah about her experience of implementing AMS in the paediatric intensive care unit within King Fahad Medical City, Riyadh.

The video highlights that antibiotic restriction alone often isn’t successful, so they complemented it with a back-end strategy, which involved prospective audit and feedback and antibiotic timeout.

The result was a drop in the use of vancomycin, piperacillin/tazobactam and meropenem.

The main challenge in their hospital was the non-automated health electronic record, which made it hard to gather reliable data monitoring antibiotic use. They also struggled to ensure their strategy was sustainable, as they faced a lack of resources, and struggled with a lack of trust from physicians.

Their main implementation was an antibiotic tracking sheet, which was filled out whenever an antibiotic was prescribed. The following information was recorded:

  • Type of drug

  • Date of prescription

  • Dose given

  • Timeout date

Every antibiotic prescribed was reviewed after 72 hours depending on culture results, continuing indication and the plan duration. By assigning an infection prevention control champion and through leadership support, they ensured accountability and over time, the levels of trust rose.

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Antimicrobial Stewardship for the Gulf, Middle East and North Africa

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