1. Pharmacist (Malaysia), NCAS mentee
Antimicrobial Stewardship in Malaysia vs Australia: Identifying and closing the gaps
presented by,
Hoey Lin Oh
Pharmacist (Malaysia), NCAS mentee

2. Overview Background AMS activities in HRPB, Malaysia
Comparison between the AMS strategies in Malaysia and Australia
Gaps
Action Plan

3. Background Healthcare system in Malaysia Public Private
Government Revenue
Individual
Health care insurance
Line Item Budget
Fee for Service
Adapted from Rozita Halina Hussein, Institute for Health System Research Malaysia. Asia Pacific Region Country Health Financing.

4. Background
National Infection and Antibiotic Control Committee, Medical Care Quality Section, Pharmaceutical Division and the Family Health Development Division
Encourage to be implemented, but not mandatory for accreditation
Outline
Policy
5 core strategies
Team: governance, role and members
Activities
Program measurement

5. Background Third largest public hospital Capacity: 990 beds Specialty:
A&E
ICU
General medical
Haematology
Nephrology
Orthopaedic
Paediatric
Surgical (General, Neuro, Paediatric, Plastic)

6. Background Started since 1st October 2013
Hospital Director
Hospital Infection Control and Antibiotic Committee (HIACC)
Antimicrobial Stewardship Team (AMS)
Started since 1st October 2013 2 ID
physicians
Clinical Microbiogist
Clinical pharmacists

7. Restriction & approval system Surveillance & feedback mechanism
Core strategies of Hospital AMS
Restriction & approval system
Formation of AMS team
Regular AMS rounds
Prospective audit
Surveillance & feedback mechanism
Protocol on Antimicrobial Stewardship Program in Healthcare Facilities. Ministry of Health Malaysia  

8. Honorary observership in Australia
Started on16th November 2016
Background of the AMS program in Australia
AMS & ID rounds in Royal Melbourne Hospital
Education session
AMS tools
Special visits
Victorian Comprehensive Cancer Centre (VCCC)
Victorian ID reference laboratory (VIDRL)
Victorian Healthcare Associated Infection Surveillance System (VICNISS)
Therapeutic Guideline Ltd (TGL)
Other hospital (AMS programs)
Research project
Started on16th November 2016

9. Comparison in the AMS strategies between Malaysia & Australia

10. AMS team D HRPB Malaysia Australia
Acute metropolitan Hospital: AMS team D
HRPB Ph
Hub and spoke model
Difference:
Workforce capacity
Hub and spoke model

11. Guidelines & protocols
Malaysia
Free
Australia
Charged
National guideline
Local guideline
Difference:
Access and adherence of the national antibiotic guideline
Availability of local guideline

12. Controlled anti-infective
Restriction and Approval system
Malaysia
Australia
Electronic approval system
MOH formulary (My BlueBook)
Controlled anti-infective 1.
IV Cefoperazone/Sulbactam 2.
IV Ertapenem 3.
IV Imipenem/Cilastatin 4.
IV Meropenem 5.
IV Levofloxacin 6.
IV Linezolid 7.
IV Polymyxin B & E 8.
IV Vancomycin 9.
IV Tigecycline
10.
IV Ceftaroline
11.
IV Voriconazole
12.
IV Caspofungin
13.
IV Anidulafungin
Any doctor
Difference:
More efficient approval system
Real time review of the antimicrobials order
Provision of decision support on antimicrobial prescribing
No delay for standard approval

13. Post prescription review & intervention
Malaysia
Australia
Triage by pharmacists
Post prescription review
Point of care intervention
Centralised assistive technology
New role of pharmacy technician in AMS
triage patients
follow up
data collection & audit
report
Difference:
Manual and time consuming
Scattered information and workflow
New role of pharmacy technician

14. Audit Malaysia Australia Annual Point Prevalence Survey
Major hospitals
National benchmarking data is not available
Antimicrobial consumption
Defined daily dose
Special audit tools
Larger number of hospitals
National benchmarking data is available
Antimicrobial consumption
Defined daily dose
Hospital antibiogram (revise local guidelines & protocols)
Difference:
Scale of the audit
Availability of benchmarking data

15. Report & feedback Malaysia Australia One way communication Difference:
One way vs interactive communication

16. Education Malaysia Australia Difference: Education for consumers
Manual vs electronic

17. Others Clinical pathway
Implementation of a nurse and/or pharmacist-led IV to oral switch antibiotic pathway and evaluation of its impact in hospitalised inpatients in the general medical units

19. Others
Victorian Healthcare Associated Infection Surveillance System (VICNISS)
State wide surveillance program
Infection control practitioner
Epidemiologists

20. Gaps identified Strategies Gaps 1. Guideline & protocols
Level of adherence to the national antibiotic guideline
Local antibiotic guideline/ protocol
2. Restriction and approval system
Manual, time consuming process, delay in approval
Poor decision support for junior prescribers
3. Post prescription review & intervention
Manual, scattered information and workflow
Time consuming
4. Audit
Only covers major hospitals
No national benchmarking data
5. Report & feedback
Variation in reporting format
One way communication
6. Education
Less focus on consumers

21. Action plan Strategies Action plan 1. Guideline & protocols
Develop the local antibiotic guideline/ protocol
Revise the members of auditors and reviewers
2. Restriction and approval system
Centralised assistive technology
Integrate the electronic system
Telehealth system
3. Post prescription review & intervention
4. Audit
Refine and enhance the audit tool
5. Report & feedback
Propose for standard template for reporting
Interactive communication
6. Education
Consumer engagement and education
Electronic material

22. Challenges Engagement of the stakeholders and healthcare team members
Implementation of innovation and technology
Resources and funding
Gaps between public and private setting
Sustainability of the programme

23. Acknowledgement Guidance, National Centre of Antimicrobial Stewardship
VIDRL
VICNISS
AMS team, RMH
VIDS team, RMH
Pharmacy department, RMH
Therapeutic Guideline Ltd