Working closely with numerous Antimicrobial Stewardship teams around the world, we know that there are many different stewardship interventions and approaches to addressing antimicrobial resistance at the local level. But building an effective program takes a lot of determination and hard work. We spoke to ASP team lead, Dr. Shaqil Peermohamed to gain his insights on the keys to building a great stewardship program.

Tell us about your role in Antimicrobial Stewardship.

Dr. Peermohamed: I joined the Division of Adult Infectious Diseases in Saskatoon, Saskatchewan in July 2016 and am the Physician Lead for our Antimicrobial Stewardship Program. Given my interests in quality improvement and medical informatics, I completed my Master of Public Health with a focus on clinical effectiveness through the Harvard T.H. Chan School of Public Health. I was an inaugural participant in Saskatchewan’s Clinical Quality Improvement Program where I assessed the impact of antimicrobial stewardship rounds on prescribing practices in critical care units. One of my favorite aspects of my job is being able to collaborate with passionate leaders across different disciplines to help optimize the use of antimicrobials and work towards protecting these precious shared resources.

What are the 3 most important components of a successful Antimicrobial Stewardship Program?

Dr. Peermohamed:

1. Collaboration – Antimicrobial stewardship is truly a multi-disciplinary effort, and it is crucial to engage key stakeholders in your initiatives.

2. Innovation – Think outside the box! In our institution, we harnessed the ubiquitous use of smartphones to distribute local guidelines, share antimicrobial resistance trends and engage with our front-line clinicians to help standardize variation, increase awareness of antimicrobial stewardship and empower frontline clinicians in optimizing antimicrobial prescribing patterns.

3. Commitment – Advocating for the appropriate use of antimicrobials is a marathon, not a sprint! Focus on collaborating with like-minded innovators and early adopters in your institution and celebrate your wins, however big or small!

What resources were most helpful to you when developing your ASP guidelines?

Dr. Peermohamed: When developing our ASP guidelines, we found it useful to reference current national guidelines and landmark trials while also reflecting upon our local antimicrobial susceptibility patterns. For example, high rates of resistance to clindamycin and azithromycin amongst our Staphylococcus aureus and Streptococcus pneumoniae isolates, respectively, impacted our local recommendations for management of skin and soft tissue infections and community-acquired pneumonia. We also found it useful to collaborate with antimicrobial stewardship champions across Canada to help build and tailor guidelines for a variety of infectious disease syndromes.

How has Firstline helped your Antimicrobial Stewardship Program?

Dr. Peermohamed: I think one of the biggest challenges in healthcare relates to the concept of muda, a Japanese term for waste. For example, in our institution, we saw significant variation in the use of antimicrobials for specific infectious disease syndromes. Reference pocket guides, pre-printed order sets often result in low rates of adoption given barriers in accessing these tools and ensuring they contain current recommendations. Given more than 90% of healthcare workers carry a smartphone to work, we collaborated with Firstline to harness the ubiquitous nature of smartphones and mobile app technology to disseminate knowledge regarding local guidelines and updating content in real-time.

Many antimicrobial stewardship programs have limited personnel and resources, and it can be challenging for antimicrobial stewardship programs to review every patient actively receiving antimicrobials. Firstline is a powerful and innovative tool that has helped us to disseminate knowledge, expand our reach and empower healthcare workers to make the right choices when prescribing antimicrobials.

What outcomes have you seen at your institution since you launched with Firstline?

Dr. Peermohamed: We initially secured funding through a College of Medicine Research Award to study the impact of Firstline on antimicrobial prescribing practices for the Saskatoon Area of Saskatchewan Health Authority. Within weeks of launching Firstline, we had over 700 active users and sustained those high rates of usage nine months later. On average, our users accessed the app 1.4 times per day for an average of two minutes and thirty-four seconds per session. Our users consist of physicians, pharmacists, residents, medical students and nurses.

Ten months following the launch of Firstline in Saskatoon, we launched a user satisfaction survey with 182 respondents from healthcare professions mirroring our active users. Here are some of the exciting survey results: 85% of respondents agree that Firstline saves them time. 88% of respondents agree that the content in Firstline is relevant to their patient population. 87% of respondents agree that Firstline improves the appropriateness of their antimicrobial prescribing patterns. 89% of pharmacists agree that Firstline encourages them to challenge inappropriate prescribing by others. 92% of respondents agree that they would recommend their colleagues use Firstline. When we analyzed antimicrobial prescribing patterns on our hospital medical wards before and after implementation of Firstline, we observed statistically significant reductions in both total (24.7%) and anti-pseudomonal (33.4%) antimicrobial usage.

We presented our findings to senior leadership and through their support and advocacy, we were able to secure funding for Firstline for all integrated service areas throughout Saskatchewan Health Authority as well as for Moms and Kids Health Saskatchewan. We are excited to continue to collaborate and expand our content!

What advice can you offer someone just starting an antimicrobial stewardship program?

Dr. Peermohamed: Harness the power of technology to help create a culture that embraces antimicrobial stewardship and collaborate with key stakeholders to build local guidelines relevant to their patient populations. Provide your prescribers with the tools and resources to engage and empower healthcare workers to make the best antimicrobial prescribing choices and standardize variation. Be creative, innovative and resilient!

Check out the guidelines that Dr. Peermohamed’s team developed for Saskatchewan Health Authority.