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Where to start: addressing the prescribing issues?

In this video Dr Adrian Brink discusses the problem
I’m talking to Dr. Dena Van Den Bergh who’s the Director of Quality Leadership in the Netcare Hospital Group in Johannesburg, who chose this particular model to commence and initiate Stewardship across a large group of hospitals. So Dena, what I’d like to know is what did you want to achieve and explain the Stewardship activities prior to choosing and implementing this model. So again, I think what was important was recognising that we really needed to do something about Stewardship. We’d heard about the problem for many years, but the question was– what do we do every day at the front line of care?
And what we did previously was rely on a model of champions who were interested in antibiotic stewardship and who implemented whatever they had learnt in their particular institutions in a very ad hoc way. So they did the best they could, but without a co-ordinated approach, we had absolutely no impact on our DDDs and our antibiotic consumption. So we had to stop and say, so what do we need to do differently? OK. But why did you chose pharmacists? Well, the trick is in South Africa, we don’t have very many infectious disease physicians. In fact, we hardly have any that are accessible to the private sector.
And we had to find a way that we could use the right level of skill to do the work and engage with the private practitioners that work in our institutions. But you used pharmacists, that aren’t even, so called ID like in the US, or even clinical pharms, which we don’t have in South Africa yet. Well again, there just aren’t enough pharmacists with their kind of qualification. But we acknowledged that pharmacists actually had the right background and that we needed to then teach them the gaps– teach them whatever they needed to know about Stewardship. So the underlying competency exists and we needed to take it to the next stage and put a structure to their process.
But how do they get time to do these basic interventions– which I’m going to talk about now. How did they– or did they have time to perform them? Well, look initially, when we used the old champion model people were finding a bit of time. But what we did for this particular work was, when we got serious about the fact that we needed to do something, we also allocated time. Now, we didn’t have full-time posts, and we couldn’t allocate lots of time to everybody, so depending on the size of the unit, we allowed pharmacists what we call allocated time to do Antibiotic Stewardship. And we prioritised their time for the highest risk areas, for the highest opportunity areas.
And then took that through and we expanded that over the time that we could. With the buy-in of the hospital manager. Absolutely.

The data shown in the introductory video to this quick win indicated the overuse and inappropriate prescribing of antibiotics throughout South Africa.

In this video Dr. Brink begins to explore with Dr. Dena van den Berg, Director of Quality Leadership, Netcare Ltd how they began to address this in a private hospital and trauma services group of institutions operated by Netcare Ltd which comprising of:

  • 47 hospitals with 44 emergency centres in seven out of nine South African provinces
  • with a total of 9424 registered beds, 1601 intensive care and high care beds
  • and 343 operating theatres.

Measurement of the impact of the AS model was conducted for a period of 104 weeks between July 2012 and September 2014.

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Antimicrobial Stewardship: Managing Antibiotic Resistance

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