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Companion animal practice – antimicrobial use guidelines

Rosanne Jepson discusses the challenges related to AMS in companion animal practice in regards to antimicrobial guidelines.
OK. Welcome to this first session, looking at some issues related to antimicrobial use and hospital hygiene. So the hospital that I’m going to be talking about is a tertiary referral hospital– the Queen Mother Hospital for Animals. And I’m going to be thinking about a number of goals in this short presentation– so how we go about thinking about developing antimicrobial policy and guidelines for this type of hospital, thinking about how to make these very easy to use and easy to apply within the hospital. We want to have a policy or guidelines that help us in terms of appropriate antimicrobial prescribing.
But we also want to have a system that gives us a forum for discussion of the complex cases that we’re typically dealing with and which may have many comorbidities. We want to try and make sure that any guidelines or policies that we introduce still allow individual clinical autonomy but make both the individual and the teams within the hospital accountable for their use of antimicrobial agents. And we want to have a system that allows us a platform for auditing and understanding the reasons behind antimicrobial prescribing within the hospital.
And at the same time, we also need to remember that part of our role, because we’re part of the university system, is to help educate undergraduate students of the future as they pass through our hospital on rotations, in terms of appropriate antimicrobial prescribing. So what are the challenges that we face? Well, we are a very large multidisciplinary hospital. We have over 100 veterinary surgeons working within our hospital. And these individuals work in many different services. They have different levels of knowledge and awareness in terms of antimicrobial prescribing. And they probably have different levels of emphasis that they’re going to be placing on antimicrobial prescribing, compared to perhaps the individual patients that they’re trying to manage.
We want to make sure that we have a policy that is available and is discipline-specific. So it’s got to be applicable to all of the individuals in the hospital. And one person obviously can’t be aware of all requirements. And we need, therefore, to try to reach consensus on the best way to be managing cases. But we don’t always have the best evidence base available in veterinary medicine. And so the antimicrobial guidelines that exist may be written from different perspectives.
And we need to make sure that they’re appropriate for our particular area of the country where we’re working in, as these may not– of the country where we’re working in, as these may not necessarily be appropriate, for example, in one country versus another. And so it’s important that we have some level of understanding of the specific antimicrobial resistance patterns that you may be seeing in your particular area of the country and in your particular hospital. We’re often dealing with very complex case loads. These individual patients often have varied and complex clinical problems. So we’re often dealing with comorbidities that may influence our choice of antimicrobial agents.
They frequently have had prior exposure, either with or without appropriate rationale for antimicrobial use. And so we’re trying to find systems that allow us to optimise clinical decision making, particularly when we start to deal with patients with known multi-drug resistant infections. We definitely need a system that’s going to be easy to implement. And this is important both in terms of compliance and also in terms of adherence. So an over-complicated antimicrobial policy or guideline is not going to work for everybody. And it’s perhaps going to be ignored if it’s too complicated to be used. And it must span all disciplines.
So we need a system that’s going to be equally as applicable to internal medicine as it is to our surgical colleagues. So although these are the challenges that I think we face at a referral hospital when it comes to developing antimicrobial guidelines, I think that, actually, there are some issues here that are fundamental challenges to everybody who’s thinking about how they use antimicrobials in clinical practice.

The steps in this next activity, challenges to achieving good antimicrobial stewardship, will discuss some barriers you may face when trying to implement AMS. Each step will discuss the barriers in the context of different species, and these will be clearly identified in the step titles.

In this video, Rosanne Jepson, an associate Professor in small animal internal medicine at the Royal Veterinary College, discusses the challenges to developing antimicrobial use guidelines in companion animal practice.

Some suggested aims to consider when developing antimicrobial prescribing guidelines are as follows:

  • Easy to use and apply in hospitals.
  • Ensure appropriate antimicrobial prescribing.
  • Provide a forum for discussion in complex cases.
  • Achieve individual and team accountability for use of antimicrobial agents.
  • Provide a platform for audit and understanding of antimicrobial prescribing.
  • Help educate undergraduate students on rotation.

The challenges to achieving these aims can vary from hospital to hospital so think about which barriers mentioned in the video are applicable to your own practice.

Think about ways that these challenges have been overcome in your own practice. Share your ideas with other learners in the comments section.

In week 2, we will discuss the ways Rosanne and her practice implemented AMS in regards to antimicrobial guidelines, despite the challenges mentioned here.

Please find a downloadable copy of the PowerPoint slides used in the video in the downloads section below.

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Antimicrobial Stewardship in Veterinary Practice

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