Antimicrobial Awareness Week

Antimicrobial Awareness Week - 18-24 November 2021

AMS after COVID-19

COVID-19 has impacted the antimicrobial stewardship (AMS) activities of many hospitals with staff being deployed to COVID-19 duties or other areas. To support hospitals with returning to their AMS initiatives, we are pleased to announce that we will be releasing a digital AMS Quality Improvement (QI) Toolkit in early 2022 – aimed to support healthcare teams to start and sustain AMS related QI projects.

The toolkit contains step-by-step guidance on using improvement methodologies and specific resources for hospitals/LHDs to adapt locally.

For this year's Antimicrobial Awareness Week, we speak to four AMS Pharmacists on how their roles changed due to COVID-19, what their plans are for resuming their AMS work and how they envision using the CEC AMS QI Toolkit.

Tony Lai

Where have you been working for the past six months and what were you doing?

I've stayed in my AMS role at The Children's Hospital at Westmead (CHW), which has served a significant catchment of Sydney's third COVID-19 wave. There have been many new opportunities to contribute as an AMS pharmacist during the pandemic at CHW during this time. These include:

  • Developing local multidisciplinary COVID-19 treatment guidelines and models of care.
  • Stewardship services of patients on COVID-19 treatment.
  • Streamlining medications to simplify administration to preserve PPE/COVID-19 staff exposure.
  • Managing access to COVID-19 pharmacotherapy through state and national stockpiles.
  • Facilitating access and supply of antimicrobials to Hospital-In-The-Home and COVID-19 Virtual Care wards.
  • Supporting clinical pharmacists on critical care and COVID-19 wards.
  • Mitigating drug shortages and supply chain interruptions.
  • Research in remdesivir pharmacokinetics in paediatrics.

What are your plans for resuming your AMS program?

Our AMS program has been scaled back since the start of the pandemic. AMS intensive care rounds are no longer in person but through zoom. The frequency for AMS rounds has been reduced to accommodate increasing infectious diseases and clinical pharmacy workloads. Modelling from the Sydney Institute for Infectious Diseases has predicted that the proportion of cases in children under 12 years will likely rise, so my AMS program plans post-COVID-19 pandemic is yet to resume. Despite this, my career plan for 2022 is to start my PhD at the University of Sydney; I've been procrastinating for way too long!

How will you be using the CEC AMS QI toolkit?

I'd like to focus on antifungal stewardship – there has been an increased number of invasive fungal disease cases, a consequence of the large amount of immunosuppressive therapies initiated for COVID-19. Would also like to sink my teeth into a vancomycin area-under-the-curve therapeutic drug monitoring project. I think the CEC AMS QI toolkit would help me to plan, carry out and lead a comprehensive QI project on these topics.

When international travel is permitted, which destination will you be heading to first?

My bucket list has always been to go the French Alpes and cycle up Alpe d'Huez. It's a bit hard now with kids, so I might have to wait until they are older, then the wife and boys can e-bike up with me. Perhaps before then, I'd love to go to Kyoto to enjoy some whisky at the Yamasaki Distillery and pig out on ramen.

Nicole Cerruto

Where have you been working for the past six months and what were you doing?

I have been working in the COVID-19 vaccination clinic and providing dispensary support to the Department of Pharmacy while other pharmacists worked in the vaccination clinics. Unfortunately, due to COVID-19, our AMS rounds were put on hold as wards became locked down and our efforts were focused on supporting the Infection Prevention and Control Service.

What are your plans for resuming your AMS program?

Our piperacillin-tazobactam usage has crept up, so that's on my to-do list to address. We had no opportunity for Quality Improvement (QI) projects during COVID-19 so our antibiotic allergy project had to be placed on hold – we’ll pick this back up when we can. Next, we have plans to upskill pharmacists in AMS and hopefully expand our AMS team. We've also teamed up with our National Surgical Quality Improvement Program (NSQIP) team to look at surgical antibiotic prophylaxis data.

How will you be using the CEC AMS QI toolkit?

We have been given the green light to do an IV-to-oral switch project, I think it would be a great opportunity to use the CEC AMS QI toolkit for this and adopt a QI approach.

When international travel is permitted, which destination will you be heading to first?

Maldives for my honeymoon!

Charlie Lao

Where have you been working for the past six months and what were you doing?

In February I was asked to help establish the SWSLHD vaccination centre at Liverpool. Following this, I was involved in setting up the vaccination centre in Macquarie Fields, and then other pop-up vaccine centres for the district in Bankstown and Prairiewood. My role was in facilitating operations and administrative tasks, including staffing the vaccination centres.

What are your plans for resuming your AMS program?

Fortunately, Liverpool Hospital was still able to manage and monitor the use of restricted antimicrobials during COVID-19. However, there were significant changes in the hospital, such as wards changing and ID consults and AMS rounds becoming virtual. Our first steps to returning our AMS program back to normal would be to start our face-to-face AMS ward rounds again and be more engaged with our peers – as this is essential to a successful AMS service.

How will you be using the CEC AMS QI toolkit?

I'd like to improve the use of cephalosporins, ceftriaxone in particular, in our facility so I think the QI toolkit would be a great backbone for that project.

When international travel is permitted, which destination will you be heading to first?

Japan

Suman Adhikari

Where have you been working for the past six months and what were you doing?

I was able to stay in my role as an AMS Pharmacist during the latest outbreak. Though my work focus significantly shifted from performing reviews of antimicrobials on AMS rounds to reviewing medications used in the treatment of COVID-19.  This involved being part of multi-disciplinary team (MDT) consisting of an ID, Respiratory Physician and Intensivist. We reviewed patient's medications and treatment pathways. My role in the team was suggesting and monitoring for any signs of adverse effects (for example, checking liver function tests, full blood count and renal function for abnormalities), checking for drug-drug interactions and therapeutic drug monitoring of antimicrobials used.

One of my achievements was leading the pharmacy COVID-19 treatment team. I played an integral part in the development of hospital guidelines for COVID-19 treatments, which was a collaboration between our Infectious Diseases, Respiratory, Intensive Care, Endocrine and Pharmacy departments. I also managed the individual patient use (IPU) applications for patients on specific COVID-19 treatments and facilitated the patient consent process of hundreds of COVID-19 inpatients.

Another one of my responsibilities was to assist in medication stock management in the ICU ensuring adequate supply, adapting as situation evolved and addressing any impending stock issues specific to treatment of COVID-19.

What are your plans for resuming your AMS program?

In 2019 I started an antibiotic allergy project, which unfortunately has been affected by COVID-19 multiple times since its inception. Prior to the last outbreak we just got our antibiotic allergy assessment form built into the eMR. So when I have capacity to again, I'd like to pick this back up and start with testing that electronic form.

How will you be using the CEC AMS QI toolkit?

Last year I completed the CEC's Executive Clinical Leadership course and used QI methodology for my antibiotic allergy project. The methodology is great and there are many wonderful tools to guide you each step of the way in an improvement project; as well as advise on what you need to do to make a project successful. It allows you to start small and grow bigger – we started the antibiotic allergy project with one patient in one ward, now we are doing across the whole hospital. I would not have been able to do this project without the QI tools or methodology.

For my next project, I'd like to look at therapeutic drug monitoring of non-standard antimicrobials (azoles, beta lactams, linezolid i.e. any test not routinely done by our own pathology service). I think it would be useful to apply the AMS QI toolkit for this project.

When international travel is permitted, which destination will you be heading to first?

My home country, Nepal. My brothers and sisters live there and it's been few years since we've all been together. My nephew's wedding ceremony in Nepal was postponed due to COVID-19 to February 2022. I'd love to attend if I could.

Relevant Australian resources

The National Centre for Antimicrobial Stewardship

The National Centre for Antimicrobial Stewardship (NCAS) will be holding a webinar series for Antimicrobial Awareness Week. Register here.

The National Antimicrobial Prescribing Survey (NAPS)

The NAPS was developed by a dedicated research team at Melbourne Health to assist healthcare facilities in monitoring their antimicrobial usage. The lead up to Antimicrobial Awareness Week may be an opportune time for NSW health facilities to participate, so that the results of your survey can be incorporated into your campaign activities and materials. For more details, please visit National Antimicrobial Prescribing Survey (NAPS).

Australian Commission on Safety and Quality in Health Care (ACSQHC)

The ACSQHC develops a wide range of resources for Antimicrobial Awareness Week, including posters, fact sheets, presentation slides and other key items. For more details, please visit Australian Commission on Safety and Quality in Health Care (ACSQHC).

Relevant international resources

Many of these international campaigns develop their own resources and host promotional activities that may be of interest.

For further information or advice about promoting Antimicrobial Awareness Week in NSW public hospitals, please send us an email.