Lab_AMS Flashcards
medicines used to prevent and treat infections in humans,
animals and plants.
ANTIMICROBIALS
Mother or umbrella term that includes antibiotics, antivirals, antifungals, and antiparasitics
ANTIMICROBIALS
Occurs when bacteria, viruses, fungi and parasites change over
time and no longer respond to medicines making infections harder
to treat and increasing the risk of disease spread, severe illness and
death.
ANTIMICROBIAL RESISTANCE (AMR)
Caused by improper utilization of antimicrobials
ANTIMICROBIAL RESISTANCE (AMR)
factors causing AMR
o evaluation of validity of prescriptions (especially e-
prescriptions)
o dispensing without prescriptions or erroneous and
invalid prescriptions
o over-prescribing of antibiotics
o patient not taking antibiotics as prescribed
o unnecessary antibiotics used in agriculture
o poor infection control in hospitals and clinics
o poor hygiene and sanitation practices
o lack of rapid laboratory tests
organizations that unite to win the war against anti-microbial resistance
DOH and WHO
Goal is to reduce the morbidity and mortality due to AMR (Philippine
Action Plan to Combat Antimicrobial resistance: One Health
Approach)
National Antimicrobial Stewardship (AMS) Program
CORE ELEMENTS OF THE NATIONAL AMS PROGRAM
Leadership
Policies, Guidelines, Pathways
Surveillance, AMU and AMR
Action
Education
Performance Evaluation
A dedicated multi-disciplinary AMS Committee and Team supported by the
hospital administration shall be responsible to successfully implement,
perform, and monitor the AMS Program in each hospital
LEADERSHIP
also part of the team that
chooses the implementation of the AMS Project
PTC and AMS Clinical Pharmacist
A team responsible for the effecting and monitoring of AMS
strategies to promote appropriate antimicrobial use shall be
created under the AMS Committee.
- THE AMS TEAM
Implementation of the AMS strategies and perform AMS
interventions as needed;
AMS TEAM
Development and review of standard treatment
guidelines and prescribing policies;
AMS TEAM
Regular collection, analysis and reporting on the
progress of the AMS program to the hospital AMS
committee, administrators and DOH;
AMS TEAM
Education of healthcare staff on appropriate
antimicrobial prescribing and resistance;
AMS TEAM
Identification and designing of systems/processes to
facilitate appropriate antimicrobial use;
AMS TEAM
Provision of expert advice on development of policies
related to appropriate use of antimicrobials and control
of AMR in the hospital.
AMS TEAM
How to solve the errors and problems encountered
ACTION
Very important not only for the team but also for the patient and
other healthcare workers
EDUCATION
At the end of the year, a report is submitted to the DOH to assess if
the AMS program is working or progressing
PERFORMANCE EVALUATION
AMS should be spearheaded by ____________ and physicians
(especially Infectious Disease Specialists) → ensure the right drug is
being prescribed at the right time for the right diagnosis or
indication.
PHARMACISTS
ROLES OF ANTIMICROBIAL STEWARDSHIP PHARMACIST
Surveillance, optimizing drug therapy, drug therapy monitoring and adherence to cpg, education/training and public engagement
T/F: Pharmacists should have access to patients’ chart
T
T/F: Pharmacists can recommend dose adjustments
T
Guidelines for AMR
7th day antibiotic stop policy
Antibiotic Restrictions
Surgical prophylaxis
exceptions for 7th day antibiotic stop policy
osteomyelitis (requires 6 weeks of
therapy)
T/F: according to surgical prophylaxis, antibiotics are taken prior to surgery and can also be taken post-op
T
Keeping up-to-date with treatment guidelines, new evidences and studies
EDUCATION/TRAINING AND PUBLIC ENGAGEMENT
Goal:
* To safeguard and ensure the optimal use of antimicrobials
* To optimize clinical outcomes of the patient
AMS INTERVENTIONAL STRATEGIES
Persuasive strategies aim to persuade health professionals to prescribe appropriately by
addressing underlying knowledge deficiencies, attitudes and/or behaviour
through _____________ and __________
active interaction and discussion
Persuasive strategies include the following:
Audit and Feedback (Prospective Audit of Antimicrobial Prescribing
and Direct Intervention and Feedback)
Point of Care Interventions (IV to PO, De-escalation, Dose
optimization)
Occur routinely at the ward level
Point of Care Interventions
With direct feedback to the prescriber/attending
physician at the time of prescription or laboratory
diagnosis
Point of Care Interventions
Advantages of Point of Care interventions
- Improves patient management and outcomes
▪ An excellent opportunity to educate clinical
staff on appropriate prescribing
Function of the clinical pharmacist
RESTRICTIVE STRATEGIES
Control the use of antimicrobials by instituting “barriers”
RESTRICTIVE STRATEGIES
Restrictive strategies includes the following strategies:
- Formulary restriction and pre-authorization
- 7
th day automatic stop policy
Requires clinicians to obtain approval for use of selected
antimicrobials before prescribing
ANTIMICROBIAL RESTRICTION AND PRE-AUTHORIZATION STRATEGY
To preserve last-line antimicrobials to use for conditions
where they are truly indicated
ANTIMICROBIAL RESTRICTION AND PRE-AUTHORIZATION STRATEGY
To help minimize unnecessary patient exposure to
toxicities and costs associated with inappropriate therapy
ANTIMICROBIAL RESTRICTION AND PRE-AUTHORIZATION STRATEGY
Scope: use of restricted antimicrobials orally and intravenously to
all patients (inpatient and outpatient settings).
ANTIMICROBIAL RESTRICTION AND PRE-AUTHORIZATION STRATEGY
Exceptions of ANTIMICROBIAL RESTRICTION AND PRE-AUTHORIZATION STRATEGY:
o Use of treatment of MDR tuberculosis under the
Programmatic Management of Drug Resistant
Tuberculosis (PMDT)
o Antimicrobial prescribed/order by an IDS or AMS
Clinician
Preauthorization of broad-spectrum antibiotics and prospective
review after______________ of treatment should form the
cornerstone of antibiotic stewardship programs to ensure the right
drug is prescribed at the right time for the right diagnosis.
two or three days
T/F:the stat/now dose or the first dose of the medication can be given prior to the result of the pre-
evaluation but succeeding dose will require approval
T
This policy shall govern the duration of antimicrobial use by
requiring prescriptions to be regularly reviewed, specifically in the
need to continue therapy beyond seven (7) days.
- 7
TH DAY AUTOMATIC STOP POLICY
7
TH DAY AUTOMATIC STOP POLICY standard operating procedure shall cover the use of all
antimicrobials administered ___________ and _________ to all patients
admitted in the hospital (inpatient setting only)
orally and intravenously
Exceptions of 7TH DAY AUTOMATIC STOP POLICY
o Use in HIV/AIDS or cancer patients as antimicrobial
prophylaxis according to guidelines; and
o Use as anti-tuberculosis antibiotics
In 7th Day automatic stop policy, the nurse or pharmacist in charge of the
patient shall alert the attending physician no later than
on the _______ day of antimicrobial therapy
6th
In 7th Day automatic stop policy, Counting is reset if
discontinued or put on hold for more than ______ hours
24
In case the AMS Officer cannot be contacted, it is
documented on the form and _____________ may dispense
the first dose; but the succeeding dose will require
approval already
Pharmacy
There is no need to fill out the 7th-day antimicrobial form if:
- Total treatment duration is intended to be ≤7 days;
-Use of the antimicrobial beyond 7 days has been
recommended by the AMS clinician, IDS or IPC
Chairperson
