Charlotte Maxeke Academic Hospital (CMAH)

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1 Antimicrobial Stewardship Activities in Public Health Care Facilities in Gauteng Province Charlotte Maxeke Academic Hospital (CMAH) January 2017-April 2018 Lungile Mabuza Deputy Pharmacy Manager

2 Hospital Profile Introduction and background Aim Study Methodology Results and discussion Wayforward Conclusion Contents

3 Hospital Profile Charlotte Maxeke Johannesburg Hospital previously known as Johannesburg General Hospital Offers tertiary services in all major discipline Main teaching hospital for University of Witwatersrand faculty of Health Sciences 1068 BEDS,4000pm admission and OPD visits pm CMJAH receives a number of referrals from a number of hospitals in its catchments area 3

4 Introduction Antimicrobial resistance (AMR) is one of the major clinical, public health and economic issues facing our generation New resistance mechanisms are emerging and spreading globally, threatening our ability to treat common infectious diseases (WHO,2017) The world urgently needs to change the way it prescribes and uses antibiotics. Even if new medicines are developed, without behaviour change, antibiotic resistance will remain a major threat.

5 Example of an MDRO report 5

6 Aim Determine the extent of irrational use of antibiotics at CMAH To establish an AMS committee within CMAH To determine the extent of AMS activities at CMAH

7 Methodology The study population mainly focus on injectable antimicrobials which are issued mainly for the inpatients Audit was conducted for 316 forms which were received in the pharmacy for 1 week period Share results of the findings within various platform within CMAH

8 Methodology Tools for analysing cost: VEN Classification system according to medicines public health value or impact It is used to prioritize medicine to assist setting health care priorities ABC Useful for analysing drug consumption and utilization 8

9 ABC Aanlysis Method by which medicines are divided according to their usage into Class A, B and C items. Percentage of items Percentage of Budget Class A Class B Class C 15-20% 10-15% 60-80% 80% 15% 5% 9

10 Example of completed ABC analysis 10

11 Results and Discussion 25% had incomplete information 16.5% submitted for antimicrobials that do not need motivation 2% prefilled forms 2.5% incorrect/outdated forms Lower Hanging Fruit AMS should be championed pharmacist with multidisciplinary collaboration

12 Results and Discussion Antimicrobial Stewardship Committee was established and endorsed by the hospital leadership Addresses issues relating to antimicrobial use including prescribing Include methods to restrict use of antimicrobial Assist in evaluating and selecting antimicrobials for formulary Monitor antimicrobial resistance patterns

13 Results and discussion New antimicrobial prescription chart (adopted from SAASP) now available and in use Lower hanging fruit intervention Educational programme as small group during academic session or one week workshop Rearrangement of Pharmacy in terms of demanders accessing (bulk) antimicrobial for prophylaxis 13

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15 Way Forward Behaviour practice Compliance to guidelines Training and Education Minimising MDRO- Emphasis on hand hygiene Reduce antimicrobial consumption and cost

16 Conclusion It always seems impossible until it is done - Nelson Mandela Presenting the new antimicrobial prescription within the hospital was a challenge Learnings-Relationship building

17 REFERENCE Management Sciences for Health Managing Access to Medicines and Health Technologies. MDS 3 rd Ed: ch40 National Department of Health. Antimicrobial Resistance Framework World Health Organisation

18 Acknowledgement CMJAH PTC and AMS and IPC Prof Richards Dr Stacey Dr Thomas Dr Nana Dr Vindana 18