Antimicrobial Stewardship in Fiji - Monash University · • A questionnaire for Doctors was...

MathewPeckTravellingScholarshipProgramFacultyofPharmacyandPharmaceuticalSciences

MonashUniversity,ParkvilleCampusMelbourneAustralia

Antimicrobial Stewardship in FijiContributions by Alistair Pickmere November 2015

and Kyle Booth January 2017

as part of the Fiji National Antimicrobial Resistance Action Plan

Senior Pharmacists Network Event May 30, 2017

TheMathewPeckTravellingScholarship• ThescholarshiphonoursMathewPeck,aBachelorofPharmacystudentwho

diedtragicallywhiletravellinginSouthAmericaaftercompletinghisfirstyearofstudy.Mathewwascommittedtoaddressinginternationalhealthissuesbyusingpharmacytoimprovepeople’slives.Thisscholarship,establishedbyhisparentsandfamily,isalegacytohim.

• WewouldliketothankthePeckfamilyforestablishingthisscholarshipinMathew'smemory,andalsothescholarshipselectioncommitteewhochoseusforthiswonderfulhonourandopportunity.OnbehalfofallthepreviousMathewPeckScholarsandusboth,thankyoutothefacultyandespeciallytothedonorswhosupportthisscholarship- withoutthem,wemaynotbeabletocontributetothisvitalresearch.

• Readaboutsomeotherscholarshiprecipientsherehttps://ozpharmavols.wordpress.com/student-placements/mat-peck-scholarship/

• MonashUniversitylinkhttp://www.monash.edu.au/pharm/alumni/support/scholarships/mathew-peck/

RepublicofFiji

PharmaceuticalExpenditure2005

The Fiji Islands

Introduction• In2014,theWHOdeclaredantimicrobialresistanceasaglobal

healththreatthatrequiresurgentcollaborativeaction.

• Alarmingratesofresistancetohospitalandcommunity-acquiredinfectionshavebeenreportedglobally,withsomeofthehighestratesreportedintheWesternPacificRegion.

• TheMinistryofHealthandMedicalServices,Fijiidentifiedantimicrobialresistanceasoneofthepriorityagendas.

• InNovember2015FijidevelopedaNationalActionPlanonantimicrobialresistancebasedonatemplateprovidedbytheWHOWPRO.

TheFijiNationalActionPlanObjectives

1. Improveawarenessandunderstandingofantimicrobialresistancethrougheffectivecommunication,educationandtraining.

2. Strengthennationallycoordinatedsurveillancesystems.

3. Optimizetheuseofantimicrobialmedicinesinhumanandanimalhealth.

4. Establishandensuregovernance,sustainableinvestmentandactionstocombatantimicrobialresistance.

ImplementationFramework§ StrategicOperationalPlan

§ ReviewandEvaluation

Implementation1. NationalAntimicrobialResistancecommitteesetupincluding

§ MinistryofHealthandMedicalServices(ChairpersonandSecretary)§ MinistryofAgriculture(includesVeterinarydept.)§ MinistryofEducation§ DepartmentofEnvironment§ DepartmentofFisheries§ MedicalInstitutions(UniversityPSMandFijiNationalUniversity)§ PrivateSector(PharmaceuticalandGPs)§ ConsumerCouncil§ CustomsAuthority§ BioSecurityAuthorityofFiji[BAF]Advisorsofthecommittee§ GMUrepresentative§ WHO(reportingtotripartiteagreement)

2. ProjectPharmacistappointed- todevelopandoverseetheimplementationofaNationalPlanofOperationsandreporttothecommittee

PlanofOperations:developedbyProjectPharmacist

Morethan50categoriesofactivitiestoaddresstheStrategicObjectivesareincorporatedincluding• Identifiedareasthatrequiredsituationanalysesorfurtherinformation

toinformthedesignofactivities- tobegatheredunderthesupervisionoftheProjectPharmacist– including

Attheendof2015tobedonebyAlistairPickmere

1. Gatherinformationabouttheknowledgeantibiotics,theiruseandresistance,ofbothprescribersandpatientsinDivisionallevelhealthservices

2. Gatherinformationsurroundingtheuseoftherestrictedlastlineantibiotic– colistin- inmajorhospitals

Atthebeginningof2017tobedonebyKyleBooth

3. GatherinformationconcerningtheunderstandingoftheconceptsofAMSbyprivateretailpharmacistsandhospitalpharmacist.

Acknowledgments1. Atthebeginningof2015,beforethedevelopmentoftheFijiNational

AMRPlan,JessicaDayment,alsoaMathewPeckScholarshiprecipient,performedastudyoftheuseoftherestrictedantibiotic-meropenem– inthemajorFijihospitalsunderthesupervisionoftheFijiMoHMSPharmaceuticalServices.

2. InAugust2015CrystalYimanAustralianpharmacist(GriffithsUni)workingwiththeFijianMoHMS&supportedbytheAustralianGovernmentvolunteerprogramcoordinatedastudyof5000Fijiansrepresentingallareasofthenation(attendinganationalfestivalinSuva)togatherinformationaboutcommunityperceptionsandunderstandingoftheroleanduseofantibiotics.

https://ozpharmavols.files.wordpress.com/2015/12/antibiotic-awareness-survey-report-final.pdf

ThefindingsofboththosestudiesalsohelpedguidethedevelopmentofthePlanofOperations.

• AllreportsofVCPstudents’studiescanbedownloadedfromhttps://wordpress.com/page/ozpharmavols.wordpress.com/60

Alistair’sStory

AlistairPickmere

B.ScB.Pharm(Hons)G.Dip.App.Sc

RoyalChildren’sHospitalMelbourne

2015MathewPeckScholarshipRecipient,MonashUniversity

Whatthisopportunityenabledmetodo• Carryouttwoinvestigationsofantibioticunderstandingand

use– fromtheprescribers’andpatients’perspectives;andoneinvestigationofcolistinuseinhospitals- inFijiinNovember/December2015,andreportfindingsandrecommendationstotheFijiMinistryofHealthinApril2016

• AttendAntibioticAwarenessWeekfunctionsorganisedbytheWorldHealthOrganisationandTheFijianMinistryofHealthgaininginsightintothepractisesandprinciplesrequiredinsuchenvironments

• FacilitatecommunicationbetweentheCWMHandMelbournebasedHospitalsfollowingmyreturntoMelbourne.

AlistairPickmereNov/Dec2015OPDStudyTogetabetterunderstandingofknowledgeaboutantibioticsinFiji,surveyswerecarriedoutundertheleadershipoftheFPBSCEssentialMedicinesAuthority1.togetabetterunderstandingoftheknowledgeandattitudesofpatientsandprescribersintheclinicoutpatientsettings.• Methods:FivebusyDivisionalHealthCentreoutpatientfacilities,thatwere

closeenoughtoSuvatoenableconvenientaccessinthetimeavailable,werechosenforinvestigation.TheEMAintroducedtheinvestigatortothestaffandpatients.

• AntibioticprescriptionsdispensedbythepharmaciesduringthepreviousweekwerecollectedfromthepharmacistsandreviewedbytheinvestigatorinthelightoftheFijiAntibioticSTG3andotherrelevanttexts.Thediagnosisassociatedwithprescribedtreatmentwasnotedontheprescriptionstoenablesuchreview.

• Apreparedpatientquestionnairewasusedasthebasisofthediscussionwithpatientswhohadreceivedprescriptionsforantibiotics.Itcoveredpatients’understandingoftheroleofantibioticsandhowtheyshouldbeused.Continuednextslide

AlistairPickmereNov/Dec2015OPDStudyMethodscontinued

• AquestionnaireforDoctorswaspreparedtocollectprescribers’perceptionsaboutrestrictions,guidelines,‘patientpressures’andpatternsmotivatingtheprescriptionofantibiotics.

• TheresultsofthequestionswererecordedinSurveyGizmosoftwareandtheresultsofopenendedquestionswererecordedbyhandforlaterentryinthedatabase.

• TheSurveyGizmowasusedtogeneraterawanalysisofthedataandtoprovidegraphicrepresentationoftheresults.Thoseresultswerecombinedwiththeinvestigator’snarrativetogenerateareport.

Forthefullreportincludingresults,discussion,conclusionsandrecommendationseehere:

https://wordpress.com/page/ozpharmavols.wordpress.com/60

InvestigatingknowledgeanduseofantibioticsatfiveDivisionalHealthCentreout-patientclinicsinFiji- 1

FindingsAnalysisofperceptionsconcerninguseofantibiotics• Theprescriptionsprovideda‘picture’oftheprevalentinfectionsbeing

treated,primarilyskinandrespiratorytractinfectionssuggestingacampaignfocussingonpersonalhygienecouldbebeneficial.

PatientSurveyresponses• Patientresponsesindicatethatthereisanurgentneedformoreand

ongoingeducationofthecommunityabouttheroleandusesofantibioticsandhowandwhentheyshouldbetaken.Theconceptofantibioticresistancewasnotcomprehendibleinthemajorityofpatients.

InvestigatingknowledgeanduseofantibioticsatfiveDivisionalHealthCentreout-patientclinicsinFiji- 2

FindingsAnalysisofperceptionsconcerninguseofantibioticsPhysicianSurveyResponses

• Physiciansresponsesconflictedthoseofthepatients- identifyingpatientpressuretoprescribeantibioticsasaregularoccurrence.Physiciansidentifiedthattheydohaveallresourcesnecessaryavailable,howevertheyarepoorlyaccessibleandused(includingcurrentSTG).

StockMaintenance

• Maintenanceofreliablesuppliesofappropriatestockisanissue.Lackofpharmaceuticalswithinthehealthserviceisunacceptableespecially whenitisduetopoormanagementwhichseemstobethecase.

Recommendations1.Basedonanalysisofprescriptions

• Considerthepreparationofprintedprescriptionformsthatencouragetheprovisionofcorrectcompleteinformationtoberecorded.

• Ensurethatallprescribershave accesstocurrentSTGs

• Considercontinuingeducationprogramsfornursesandphysicians

• ImplementacommunityhygienecampaignthatincludesscabiespreventionandtreatmentincollaborationwiththeConsumerCouncil.

• Implementandroutinelyrevisedatacollectionofprevailinginfections,antibiotictherapiesutilisedandapparentresistanceswithinthedivisionalhealthcenters

• EnsurethattheMoHMS websiteisup-to-datewithinformationandreferencesthatarerelevanttoantimicrobialmanagementinFiji.

Recommendations2.BasedonPatients’responses

• Implementongoingeducationinthecommunityabouttheroleandusesofantibioticsandhowandwhentheyshouldbetakenaswellas theconceptofantibioticresistance

• Distributeleafletsanddisplaypostersinclinics,retailpharmaciesandchurchesanddevelopandpresentregularRadio andTVspots.

• PartnerwiththeConsumerCouncilofFijiasmuchaspossible

• Provideeducationmaterialfordeliveryinregularshortsessionsofwaitingroomeducationbyclinicstaffthatcanbeprovidedatatimejudgedtocatchmostpatients.

Recommendations3

BasedonPhysicians’responses

• Considerinvestigationoftheresistancepatternofchestinfectionstoassessamoxicillinresistance.

• DevelopownershipofSTGs- ProvideAntibioticSTGs(ASTG)toeveryindividualmedicalstudentandprescriberinFiji,ensureindicatedmedicinesinstock to allowforadherencetoSTG

• DevelopfurthereducationfordoctorsincollaborationwiththeFijiMedicalCouncilandfornurseswiththeFijiNursingCouncil.

• IncollaborationtheUniversityMedicalFaculty,theFijiMedicalCouncilandtheFijiSchoolofNursingincludeCPDpointsforthiscontinuingeducation

Recommendations2Donations(ItwasfoundthatdoctorsinclinicshadbeenaskingfordonationsofmedicinesfromTaiwan– againsttheNationalFijiDonationGuidelines)

• DistributetheFijiDonationGuidelinesasabrochuretoallclinicsandprovidetheFijiMedicalCouncilwithcopies.

• ProvideFijiDonationGuidelinesasabrochureandasfullcopytoMoHMSofficialsandrelevantFijipoliticians

• ProvideFijiDonationGuidelinesasabrochuretoRotaryandothersimilarclubs.

• ProvideFijiDonationGuidelinesasabrochuretoallforeignmissions

• Maintainappropriatestocksothattherewillbenoincentivetolookfordonations.

Recommendations

2.Stockmaintenance

• Maintaincorrectstocklevelsinallhealthfacilities,§ prescribeaccordingtotheSTGs

§ maintainrecordsofpatientconditionsandtreatmentsand

§ usethedatatogenerateordersfortheappropriatequantities.

• FPBSCwillsupplyorderformsthatfacilitateappropriatequantificationandordering,andwillexamineordersandconsultappropriateclinicalstaff.

AlistairPickmere- 2- ColistinstudyIntroduction:Colistinisanexpensive‘last-resort’broad-spectrumantibacterialagent,thatisusedtotreatmulti-resistantAcinetobacterbaumannii(anopportunisticorganismthatoftencausesnosocomialinfections)andcertainother spp.Therefore,colistinuseandmisuseraisesthepotentialforthedevelopmentofsignificantbacterialresistancewithprofoundclinicalimpactontheFijianhealthcaresystem.AstudywasundertakentodeterminetheextentoftheintravenoususeofcolistinandtherationaleandreasonsforitsuseinthreehospitalsinFijiduringthetimeithasbeenavailableinFiji.

Methods:Recordsoftreatmentweresoughtandanalysedforpatientswhohadbeentreatedwithcolistin.Informationfromphysicianswasgatheredabouttheiruseofcolistin;MicrobiologyandInfectiousDiseasesteamswereinterviewed;costissueswereexploredandresistancepatternsoforganismswereexamined.

Investigatingcolistin usageinFijiattheColonialWarMemorialHospital,LautokaHospitalandLabasa Hospital

fromAugust2014toNovember2015

Patientcharacteristics

• Therewereatotal25patients - 24Adult(16andabove),1paediatricpatient.Only6hadfullmedicalprofilesandrecordsavailable.

• 14patientswhorequiredcolistininprevious18monthshaddiedfromassociatedconditions.

• Allpatientswerewithintheintensivecaresetting,apartfromonewhichwaswithintheAcuteSurgicalUnitawaitingtransfertoICU.

• Onepatientwasidentifiedassuitableforcolistintreatmentbutdied followingtransferfromLabasa toCWMH

InvestigatingcolistinusageinFijiattheColonialWarMemorialHospital,LautokaHospitalandLabasa Hospital

Infectioncharacteristicsnecessitatingcolistinusage

• Acinetobacterbaumanniiwastheorganismofinfectionin19cases,AcinetobacterJuniiintwocases,followedbythreeinfectionsbyPseudomonasaeruginosaandanunmarkedMRO.OrganismswereidentifiedfromBloodCulture,PleuralAspirate,TrachealAspirate,PeritonealFluid,Sputum,IDCtipsandWoundSwabs.

Colistinstudy:Results,ConclusionsandrecommendationsPatientrecords

• Comprehensivepatientrecordsarenotroutinelymaintainedandretrievablesodruguseevaluationstudies(DUEs)cannotbeundertaken,diagnosesstatisticscannot bemaintainedandquantitiesofmedicinesneededfortreatingthosedisease/conditionscannotbeestimated.

Stock-outs• Therearestock-outsofmedicinesinthewards,infectioncontrolconsumable

andequipment,laboratorysupplies.Thissituationundermineseveryaspectofpatientcareinthehospitals.

• PatientTreatment• Patientstreatedwithcolistinweresufferingfrominfectionsthatwarranted

prompttreatmentwithcolistin.• Inadequateinfectionpreventionandcontrol(IPC)(oftenduetoinadequate

supplies)fosteredthedevelopmentofnosocomialMDRorganisms.• Thereissuboptimalunderstandingamongprescribersoftheuseofprotocols

andstandardtreatmentguidelines(STGs)andthesedocumentsarenotalwaysreadilyavailablesoadetailedguidelinefortheuseofcolistinisneeded.ThethirdeditionoftheAntibioticGuidelineswaspublishedin2011.Itistimeforthattoberevised.

PhysicianSurveyResponse

• Therewereindicationsthatprotocolsforuseofcolistinwerenotreadilyavailableornotconsultedandtimelyaccesstocolistinwhenitwasindicatedwasnotgood.Thereseemedtobepoorinter-departmentalcoordinationbetweenmicrobiology,pharmacy andmaintenanceofadequateIPC,thatledtoentirelyunfavorablepatientoutcomes.

• Therewassomeperceivedneedforempiricaluseofcolistin

InfectionPreventionandControl(IPC)Response

IPCiscompletelyinadequate. Thereishighlydetailedrecordkeepinghoweverinadequatemonitoring,withlittleintervention.ThereisnobudgetorallowanceortimegivenforIPCeducation,trainingandresourcing.Noguidelinesorprotocolsarewritten.Thereisrelianceon‘lackofbudget’,asthereasonforinadequate activities.AneonatalintensivecareunitoutbreakatCWMcost$32,000FD.Thereisveryinadequatesupplyofbasicantimicrobialsupplies: soaps/disinfectantsandotherequipment.

InvestigationreportsDrugUseEvaluationReportInvestigatingcolistinusageinFijiattheColonialWarMemorialHospital,LautokaHospitalandLabasaHospitalfromAugust2014toNovember2015

(AlistairPickmere,RashikaGounder,JeremaiaMartaika,BeverleySnell).

InvestigatingknowledgeanduseofantibioticsatfiveDivisionalHealthCentreout-patientclinicsinFiji,November,2015(AlistairPickmere,NarginaMacalinao,JeremaiaMartaika,BeverleySnell).

BothreportssubmittedtotheMinistryofHealthFijiinApril2016https://wordpress.com/page/ozpharmavols.wordpress.com/60

WhatIhavedonefollowingthisopportunity• Continuedbuildingontherelationshipsbuiltduringmytime,

andfacilitatednewlinesofcommunicationbetweenFijiandamajortertiaryhospitalin

• BuildingrelationshipsalongsidepreviousMathewPeckScholarshipRecipientsininternationalaidprojects.

• GainedaninternshiptheRoyalChildren’sHospitalMelbourne,andbeenallocatedastheInfectiousDiseaseIntern.

• Maintainedactiveinterestandsupporttofuturescholarshiprecipients.

THANKYOU

NowovertoKyle

Kyle’sStory

KyleBooth

VictorianCollegeofPharmacy

MonashUniversity

2016MathewPeckScholarshipRecipient,MonashUniversity

KyleBooth:InvestigatePharmacists’understandingofAMSconceptsinbothretailandhospitalsettings

UndertheguidanceoftheFijiNationalAMSProgramProjectPharmacist,MsRashikaGounder,studieswereundertakentoobtaininformationabouttheexistingunderstandingbypharmacists,inretailandhospitalsettings,ofAMSconceptswhichwouldinformthestrategiestobedevelopedintheFijiNationalAMSprogram.

ApprovalwasgrantedbytheFijiMinistryofHealthandMedicalServicesResearchandEthicsdepartmentandbytheFijiPharmaceuticalSociety

Whatthisopportunityenabledmetodo• Carryouttwoinvestigationsofunderstandingoftheconceptsof

AntimicrobialStewardship(AMS):amongretailcommercialpharmacistsandhospitalpharmacistsinFijiinFebruary2017,anddevelopareportfortheFijiMinistryofHealthandMedicalServices(MoHMS)

• CommutearoundSuvaandsomeneighboringvillagestovisitretailpharmacies,speaktoeachpharmacist,andobtainanswerstothestudyquestionnaire.

• VisitthemajorhospitalstotalktoPharmacistsandPharmacyTechniciansabouttheirunderstandingofAMS– travellingbyroadtoLautokaandbyairtoLabasa.

• AnalyseanddiscussthefindingsoftheseinvestigationswithFijiancolleagues.

• LearnanenormousamountaboutAMRandAMSissuesandpharmaceuticalsystemsinFiji.

• MeetwithAustralianvolunteersworkinginFijiandexploreandenjoyextra-curriculaactivitiesaroundFiji– aboveandbelowwater.

Myassignment

• Myresearchwasdrivenbytwostudies;onedirectlywithpharmacistsintheSuvaareawhoworkedinretailpharmacies,whiletheotherconsistedwithclinicalpharmacistsinthreemainFijianhospitals.Bothstudiesfocusedontheunderstandingoftheconceptofanantimicrobialstewardship,throughaquestionnaire-basedsurveythatIbuiltinthefirstweekofmytripunderthesupervisionoftheFijianAMSProjectPharmacist.

StudyofFijiHospitalPharmacists’UnderstandingoftheConceptofAntimicrobialStewardship

Methods1• AuthorisationwasobtainedfromtheMoHMSStatisticsandEthics

Department.• AquestionnairewasdevelopedbytheAMSprojectpharmacistandthe

interviewerandfieldtestedbeforebeingfinalised• AshortexplanationofAMSwasprepared.• PharmacistsandpharmacisttechniciansworkinginColonialWarMemorial

Hospital(CWMH),LautokahospitalandLabasaHospitalwereidentifiedbythePrincipalPharmacistineachhospitaltheninterviewedindividually.

• Questionswereaskedexactlyaccordingtothepreparedquestionnaireandtheanswerswerenotedmanuallyonaprintoutofthesurvey.Respondentswereencouragedtoprovidemorethanoneanswer.Continuednextslide

Methods2• Answersgivenbytherespondentswererecordedinawaythatenabled

theirrecordinginthesoftwareforlaterinterpretation.• IftheiranswersrelevanttoAMSindicatedtheywereunsureofthe

meaningofAMStheywereprovidedwiththeexplanatoryleaflettoreadbeforethesubsequentquestionswereasked.

• Aftercompletingtheoralquestions,thepharmacistswereaskedtocompleteashortwrittenquestionnaire.

• Surveygizmosoftwarewasusedtorecordthequestionsandresponsesandtoprovedagraphicrepresentationoftheresults.

Hospital pharmacy waiting area

Summariseddiscussionofresults1Understandingrationaluseofantibioticsandantibioticresistance.• Therewasgoodawarenessofthenatureofantimicrobialresistanceandthe

factorsthatcontributetodevelopmentofresistanceandagreementthatrationaluseofantibioticsisessential.

• Therewasagreementthatuseofantibioticscouldbeimprovedgreatlybutbarrierswouldneedtobeaddressed.CompliancewithandorientationabouttheABSTG2011isimportantbutthepublicationneedstobeupdated.

• Nursesalsohavearoleinthemaintenanceofrationaluseofantibioticsandtheirroleneedstobedefinedandstrengthenedbyongoingeducation.

• Patientpressuretoprescribeantibioticsforinappropriateconditionsisstrong.Ongoingeducationofhealthprofessionalandthepublicisneeded- notjustduringtheannualAntibioticAwarenessWeek.

• Thereisinsufficientattentiontolaboratoryresultsbuttheslowturnaroundfromthelaboratoryoftenledtoempiricaluseofsecondlineorlastlineantibiotics.

Summariseddiscussionofresults2Understandingrationaluseofantibioticsandantibioticresistance.• Stockmaintenance:Intheabsenceofsufficientstockoftheappropriatefirstline

antibiotics,secondlineorrestrictedantibioticswereused.Thisfindingisinlinewiththefindingsofthemeropenem useandcolistinusestudies.

• Thestockissuescanbeeasilyresolved.Recordsofpatientconditionsandtheantibioticsappropriateforthoseconditionsmustbethebasisofre-orderingstock.Pharmacistshaveamajorroleinensuringthemaintenanceofthissystem.

• Shortageofstaffhasamajorimpactonmaintainingappropriateuseofantibioticsandthereforeoptimaltreatmentofpatients.Appropriatestaffinglevelswouldleadtoavailabilityofsufficienttimetoundertakethenecessarytasks.Specialisttrainersshouldbeengaged.

• Communicatingwithprescriberspresentsadditionalproblems– theyarehardtofindandsometimesdonotappreciatethefollow-uptoclarifyprescribingissues.

ExtensiontotheLabasaHospitalforA&E,Antenatalcare,EyeClinic,builtbySouthKoreain2009

Patients needing referral from Labasa to Suva are sent by air. This extension provides intermediate services

StudyofFijiRetailPharmacists’UnderstandingoftheConceptofAntimicrobialStewardship

Methods1• PermissiontoundertakethestudywasobtainedfromtheFijiPharmaceutical

SocietyandtheMoHMSethicscommittee.• AquestionnairewasdevelopedwiththehelpoftheAMSprojectpharmacist.

Thequestionnairewasfieldtestedinoneretailpharmacy(thatwouldnotbeincludedinthesurvey)beforebeingfinalised.

• AshortexplanationofAMSwasprepared.• RetailPharmaciesintheSuvaareawereidentifiedandthepharmacistincharge

ofeachwas contactedbytelephonebytheprojectpharmacistbeforethevisitbytheinvestigator- toexplaintheaimsofthestudyandtheimportanceofinformationtheycouldprovide.

• Beforetheinterview,pharmacistswereaskedtoreadandsigntheintroduction/consentletter. Theaimofthesurveywasexplainedandthepharmacistinchargewasinterviewed.

• (tonextslide).

Studyof FijiRetailPharmacists’UnderstandingoftheConceptofAntimicrobialStewardship

Summariseddiscussionofresults1

• Qverall,responsesdemonstratedthatpharmacistsshowedgoodawarenessofthenatureofantimicrobialresistanceandthefactorsthatcontributetodevelopmentofresistance

• Itwasrecognisedthatresistanceisdevelopingwiththeresultthatstrongerantibioticswillbeneededandstrongerantibioticswillnotalwaysbeavailableandaffordable.

• ItwasrecognisedthatgloballyMRSAincidenceisrisingandtreatmentisnotaseffective.UnfortunatelytherearenodataproducedinFijiinaformatthatallowstrackingofcurrentFijianresistance.

• ItwasalsorecognisedgenerallythatcurrentrestrictedantibioticsneedtobeconservedbystrictcontroloftheirusebuttherewasincompleteawarenessoftheexistenceofABthereforetheprivatesectormusttobeincludedroutinelyinrationaluseofmedicinesactivitiestonextslide

• Controlofprescribingisneededintheprivatesectoraswellasthepublicsectorsoneedstobeincludedinnationalcampaignsforrationalprescribing.AlthoughtheFijiNationalMedicinalProductsPolicy(NMPP)statesthatstandardtreatmentguidelinesaremeanttoguideprescribingthroughoutFiji,inpracticethatdoesnotseemtohappen

• Somepharmacistswilldispenseantibioticswithoutprescriptionssoregulatorycontrolmustbeenforced.

• Patientpressurecancontributetothesupplyofunnecessaryandunprescribedantibiotics.

Tonextslide

• AlmostallrespondentsbelievedantimicrobialresistanceisalreadyaseriousprobleminFiji.Themarginaluseofmicrobiologyteststoguideprescribingofantibioticstogetherwiththeempiricaluseofstrongerbroadspectrumantibioticsisamajorcontributor.LackofawarenessinbothhealthprovidersandtheFijicommunityneedstobeaddressed.

• Thosewhowerelesssurethatresistanceisalreadyaproblemfeltthatmoreresearchwasneededtodeterminetheextentoftheproblemandmonitoringneedstoberoutinelydoneintheprivatesectoraswellasinthepublicsector.

• Concerningsomeissuestherewasnoconsensus.Forexamplesomebelievedcounsellingpatientswasundertakenwhileothersbelieveditwasnot.Thisresponsedemonstratesthatthereissomevariationinthepracticesinretailpharmacies.

StudyofFijiPharmacists’UnderstandingoftheConceptofAntimicrobialStewardship

OverallFindings1• Thereweredifferencesbetweentheretailandthehospitalpharmacists.• Inallthreehospitals,notmanypharmacistsunderstoodtheconceptofwhat

AntimicrobialStewardshipbutmostwereabletoexplainsomeofthestewardshipobjectivestheyalreadyfulfillaspharmacists.AllpharmacistsIsurveyedagreedthatasapharmacistitwasnecessarytohaveaprominentroleinastewardship

• Positively,eachpharmacistunderstoodtheinfluencetheycouldhaveonthegrowingissueofresistance.

• Therewereconcernswithprescribersandtheirmethods,andaboutretailpharmacistswhogaveantibioticsoverthecounterwithoutprescriptions

• RetailPharmacistshighlightedhugeissueswithindividualsonlypurchasingafewdaystreatmentwithantibioticsinsteadofafullcourseduetounaffordability.

OverallFindings2• AllpharmacistscouldlistthebenefitsofhavinganAntimicrobialStewardship

inplace,buttheywouldalsolistbarrierstheywouldfaceforasuccessfulimplementation:Humanresources,finances,awarenessandtime

• Poorcommunityhealthliteracywasabigconcern.Inappropriateuseofantibioticsforsymptomaticreliefofheadaches,painandespeciallythefluwascommon

Recommendations1RecommendationsweremadeincollaborationwiththeProjectPharmacistandmyAustraliansupervisor.

HospitalPharmacists

• Increasethestaffinglevelsofthepharmacydepartmenttoaneffectivelevelsupportedbyarealisticsalary.

• ProvideadequatetrainingandresourcesupportfortheimplementationofoptimalAMS.

• Ensurethatundergraduatecurriculainmembersofteamsofhealth-relatedprofessionsinthehospitalsettingincludeRUM,AMRandAMS.

• Addressthestockissuesasaprioritybyintroducingandmaintainingasystemofrecordkeepingthatwillleadtoquantificationofneedsofappropriatesuppliesoftherightmedicines.Reliablesuppliesoftherightmedicineswillbeensuredbybasingordersontheaccuratelykeptpatientrecordsofdiagnosestreatedappropriately.

Recommendations2(HospitalPharmacy)

• StrengthentheroleoftheNationalMedicinesandTherapeuticsCommitteeanditsrelationshipwithallhealthcareworkers

• UpdatetheAntibioticStandardTreatmentGuidelinesasapriority,distributeitandpromoteitsuse

• Developandimplementasystemforroutineregularauditofantibioticprescribingandpatientresponsetobeundertakenbyhospitalpharmacists(dependingonstafflevelsbeingadequate).

• Developandimplementastrategyforateamapproachbetweenallhealthcareworkersandmutualrecognitionoftheroleofallteammembers

• Developasystemforfollowingupresultsoflabtestssotheappropriatemedicinesareavailable,dispensedtothepatientsandrecordedappropriately;andtheireffectmonitored.

• Developthenecessarytoolsandtrainpharmacystafftomonitoractivitiestoensuretheaboveactionsareoccurringcorrectly.

Recommendations1(RetailPharmacy)

IncollaborationwiththeFijiPharmaceuticalSociety(FPS)pharmacistsshouldbeequippedtoparticipateintheAMSprograminFiji.

• Ongoingcollaborativelinksmustbedevelopedandmaintainedbetweenthepublicandprivatesectorsofpharmacy.

• Privatemedicalpractitionersmustbeincludedinprogramstopromotetheuseofantibiotictreatmentguidelinesthatmustbecurrenttogaincredibility.

• TheAntibioticStandardTreatmentGuidelines2011mustbereviewedandupdatedasapriority

• TheFijiMedicalSocietyshouldbeactivelyinvolvedininitiativesanddevelopco-ownershipoftheAMSprogram

• Fiji’sretailpharmacistsmustbeincludedinnationaleducationactivitiestostrengthentheircapacitytoparticipateinallrationaluseofmedicineinitiatives– notjustconcerningantibiotics.

Recommendations2(RetailPharmacy)

• TheAMSprogramactivitiesmustincludemechanismstostrengthenateamapproachtoAMSsoeachteammemberwillvalueothersandgoodtwowaycommunicationbetweenmedicalpractitioners,pharmacists,nurses,consumersandotherswillbetheresult.

• TheMedicinesRegulatoryAuthorityandthePharmacyProfessionsBoardmusthaveactiveconnectionswithretailpharmaciesthroughofficialinspectorstoidentifyandreportonanycontraventionsofpractices.BreacheswillbedealtwithappropriatelybytheTribunalappointedforthepurpose.

• ComprehensiverecordsofpatientprescriptionsmustbekeptaccordingtotheFijiGoodPharmacyPracticeGuideMarch2017.Regularauditsofantibioticprescriptionsshouldbeundertakentoidentifytargetsforinterventionsandeducation.

• TheConsumerCouncilofFiji(CCOF)mustbeinvolvedinnationaleducationprogramstostrengthenAMS.COCFisateammemberintheAMSprogramandconsumersarepartofthewholecommunityaffectedbyAMR.

This activity was introduced by the MoHMS during Antibiotic Awareness Week 2016

Continues twice a week with full participation(stay healthy to minimise need for antibiotics)

Thank you

ReferencesFijiNationalMedicinalProductsPolicyhttp://apps.who.int/medicinedocs/documents/s21601en/s21601en.pdf

FijiNationalPlanonAntimicrobialResistancehttp://www.wpro.who.int/southpacific/mediacentre/releases/2015/Fiji_launches_AMR/en/ andhttps://ozpharmavols.files.wordpress.com/2017/05/amrplannapfiji2015.pdf

FijiNationalAntimicrobialResistancePlan:OperationalPlan2016-2018https://ozpharmavols.files.wordpress.com/2017/05/operational-plan-2016-2018.pdf

FijiGuidelinesforDonationsofMedicalSuppliesandEquipmenthttp://www.health.gov.fj/wp-content/uploads/2014/05/Guidelines-for-Donations-of-Medicines-Medical-Supplies-and-Equipment.pdf

FijiAntibioticStandardTreatmentGuidelines2011http://www.health.gov.fj/wp-content/uploads/2015/04/Antibiotic-Guidelines-3rd-edition-2011.pdf

Antimicrobial Stewardship in Fiji - Monash University · • A questionnaire for Doctors was...

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P.I/Fiji/fiji 1996... · Web view_______________________________________________________________________________________________________________________ ³ ³ Born in Fiji. ³

Internal medicine prescribers' knowledge of medications

Health Economics for Prescribers Lecture 1: Economics, Health and Health Economics Health Economics for Prescribers Richard Smith (MED) richard.smith@uea.ac.uk

Prescribers of Drugs

New Preferred Drug List Information for Prescribers

MORELAND CITY COUNCIL - City of Monash | Monash Council

FIJI POLICE FORCE - Parliament of Fiji

Monash University Clayton campususers.monash.edu/~nikhilm/nikhil_files/campus_map.pdf · Monash Child ren’s t e E1 162 Monash Co lege F2 73 Monash Connect D3 10 Monash House E2

POLICY AND PROCEDURE DEPARTMENT: DOCUMENT NAME: …...Alert prescribers to potential problems, such as drug interactions, drug non-adherence, overutilization, multiple prescribers,

Monash University Clayton campususers.monash.edu.au/~rprakash/pdf/Clayton_campus_map_bldg_82.pdf · Monash Oakleigh Legal Service E1 160 Monash S.T.R.I.P. D1 75, 76 & 77 Monash Science

Clozapine Prescriptions - Prescribers · Clozapine Prescriptions - Prescribers Quick Reference Guide For inpatients, discharge prescriptions are created as part of discharge reconciliation

About Fiji fiji - naughtone.com

BSc (Monash), GradCertBus(Mkt) (Moorabbin TAFE ...€¦ · BSc (Monash), GradCertBus(Mkt) (Moorabbin TAFE), GradDipMkt (Monash), MBus(Mkt) (Monash) Submitted in total FULFILMENT of

The Future: A Strong Fiji, A Fair Fiji, A Healthy Fiji

Practical Pointers for Prescribers, Pharmacists and ...scopioidsummit.org/.../2017-Opioid-Summit-Practical-Pointers-for...S… · Practical Pointers for Prescribers, Pharmacists and

FIJI. Fiji on the world map Fiji is in the Pacific Ocean

Advanced Pharmacology for Prescribers

Why study at Monash University? - Direct Talk · MONASH University –Scholarships to International Students Scholarship Monash International Leadership Scholarship Monash International

ASBM European Prescribers Survey

A Guide to Promoting Your Pharmacy to Prescribers › hc › en-us › article... · A Guide to Promoting Your Pharmacy to Prescribers The prescribers who practice near your store