Multi-drug resistant tuberculosis related adverse drug reactions: implementation of a documentation tool
- Authors: Cheng, Amber
- Date: 2019
- Subjects: Multi-drug resistant tuberculosis
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/44662 , vital:38151
- Description: Multi-drug resistant tuberculosis (MDR-TB) is an ever-growing problem in South Africa (SA). According to the literature, minimal documentation is done on adverse drug reactions (ADRs), specifically in the MDR-TB population. Co-administration of medications is typical for the treatment of drug resistant forms of TB, which leads to high incidences of ADRs during the treatment period, especially in patients with comorbid disease states. This before-and-after study investigated the impact of an intervention (education training presentation and implementation of a purpose-designed documentation tool) on the current documentation pattern in a public sector hospital in the Nelson Mandela Metropole. In order to measure the sustainability of the intervention, the study compared data from the pre-intervention phase to data collected from the post-intervention immediate phase and post-intervention delayed phase. Study results indicated that the intervention appeared to have had a positive effect on the frequency and variety of ADR documentation (2.1 and 1.3 fold increase, respectively) related to MDR-TB by the hospital staff of a public sector hospital, however, the positive change was not sustainable for longer than a three month period post intervention. It is recommended that factors such as: proper adoption; management; and additional resources are required to implement positive changes to documentation practices. Further studies need to be conducted in South Africa regarding the treatment of drug resistant tuberculosis, in order to establish safer treatment guidelines and more promising ADR reporting practices, which will ultimately improve patient care.
- Full Text:
- Date Issued: 2019
- Authors: Cheng, Amber
- Date: 2019
- Subjects: Multi-drug resistant tuberculosis
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/44662 , vital:38151
- Description: Multi-drug resistant tuberculosis (MDR-TB) is an ever-growing problem in South Africa (SA). According to the literature, minimal documentation is done on adverse drug reactions (ADRs), specifically in the MDR-TB population. Co-administration of medications is typical for the treatment of drug resistant forms of TB, which leads to high incidences of ADRs during the treatment period, especially in patients with comorbid disease states. This before-and-after study investigated the impact of an intervention (education training presentation and implementation of a purpose-designed documentation tool) on the current documentation pattern in a public sector hospital in the Nelson Mandela Metropole. In order to measure the sustainability of the intervention, the study compared data from the pre-intervention phase to data collected from the post-intervention immediate phase and post-intervention delayed phase. Study results indicated that the intervention appeared to have had a positive effect on the frequency and variety of ADR documentation (2.1 and 1.3 fold increase, respectively) related to MDR-TB by the hospital staff of a public sector hospital, however, the positive change was not sustainable for longer than a three month period post intervention. It is recommended that factors such as: proper adoption; management; and additional resources are required to implement positive changes to documentation practices. Further studies need to be conducted in South Africa regarding the treatment of drug resistant tuberculosis, in order to establish safer treatment guidelines and more promising ADR reporting practices, which will ultimately improve patient care.
- Full Text:
- Date Issued: 2019
Pharmacists’ perceptions of the effects of the Consumer Protection Act of 2008 on the pharmacy profession in South Africa: an exploratory study
- Authors: Cumberlege, Karin
- Date: 2019
- Subjects: South Africa -- Consumer Protection Act, 2008 , Consumer protection -- Law and legislation -- South Africa Pharmacists -- Legal status, laws, etc. -- South Africa Pharmacy -- Practice -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/38057 , vital:34312
- Description: The pharmacy profession is highly regulated through a number of statutes and codes all of which are devised in the public interest. The Consumer Protection Act, No 68 of 2008 (CPA) is a relatively recent addition to these regulatory measures and purports to protect consumers in their relations with suppliers, which includes the pharmacist-patient relationship. Heightened consumer awareness is increasing litigious consumer behaviour, making it important for pharmacists to be aware of their legal duties as providers of pharmaceutical care to consumers and therefore, to appreciate the potential implications of the CPA. This study aimed to determine South African pharmacists’ perceptions of the potential effect of the CPA on the pharmacy profession. Specific objectives included establishing the extent to which pharmacy law and ethics are incorporated into pharmacy curricula at various tertiary pharmacy institutions. The literature review identified the pharmacy categories providing pharmaceutical care services, whilst investigating medico-legal aspects of such services. Selected consumer rights in the CPA were considered in the context of pharmacists’ ethical obligations to consumers, thereby identifying potential areas of liability for pharmacists. Content and curriculum development pertaining to pharmacy education and training, focusing on pharmacy law and ethics, were assessed. A mixed methods research design was used to achieve the aim of the study. This included focus groups, telephone interviews, and a questionnaire survey amongst registered pharmacists. The themes identified in the focus groups were included in the telephone interviews. Likewise, themes identified from both the focus groups and telephone interviews, were incorporated in the questionnaire survey. The results identified a disparity in pharmacists’ education and training received from the respective tertiary pharmacy institutions. The results showed that pharmacists do not necessarily appreciate the potential implications of the CPA for pharmacists, portending an increased likelihood of liability. This finding also has implications for the training of pharmacists.
- Full Text:
- Date Issued: 2019
- Authors: Cumberlege, Karin
- Date: 2019
- Subjects: South Africa -- Consumer Protection Act, 2008 , Consumer protection -- Law and legislation -- South Africa Pharmacists -- Legal status, laws, etc. -- South Africa Pharmacy -- Practice -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/38057 , vital:34312
- Description: The pharmacy profession is highly regulated through a number of statutes and codes all of which are devised in the public interest. The Consumer Protection Act, No 68 of 2008 (CPA) is a relatively recent addition to these regulatory measures and purports to protect consumers in their relations with suppliers, which includes the pharmacist-patient relationship. Heightened consumer awareness is increasing litigious consumer behaviour, making it important for pharmacists to be aware of their legal duties as providers of pharmaceutical care to consumers and therefore, to appreciate the potential implications of the CPA. This study aimed to determine South African pharmacists’ perceptions of the potential effect of the CPA on the pharmacy profession. Specific objectives included establishing the extent to which pharmacy law and ethics are incorporated into pharmacy curricula at various tertiary pharmacy institutions. The literature review identified the pharmacy categories providing pharmaceutical care services, whilst investigating medico-legal aspects of such services. Selected consumer rights in the CPA were considered in the context of pharmacists’ ethical obligations to consumers, thereby identifying potential areas of liability for pharmacists. Content and curriculum development pertaining to pharmacy education and training, focusing on pharmacy law and ethics, were assessed. A mixed methods research design was used to achieve the aim of the study. This included focus groups, telephone interviews, and a questionnaire survey amongst registered pharmacists. The themes identified in the focus groups were included in the telephone interviews. Likewise, themes identified from both the focus groups and telephone interviews, were incorporated in the questionnaire survey. The results identified a disparity in pharmacists’ education and training received from the respective tertiary pharmacy institutions. The results showed that pharmacists do not necessarily appreciate the potential implications of the CPA for pharmacists, portending an increased likelihood of liability. This finding also has implications for the training of pharmacists.
- Full Text:
- Date Issued: 2019
Pharmacy personnel practices with regard to the sale of non-prescription asthma medication in community pharmacies in the Eastern and Western Cape
- Gebers, Benjamin Herman Charles
- Authors: Gebers, Benjamin Herman Charles
- Date: 2019
- Subjects: Pharmacy -- Practice , Pharmaceutical services -- South Africa -- Eastern Cape Pharmaceutical services -- South Africa Western Cape Drug utilization Asthma
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/39752 , vital:35354
- Description: Short Acting Beta Agonist (SABA) inhalers in South Africa are available to patients without a prescription from an authorised prescriber. This study utilised a mystery shopping technique to observe, record and compare the dispensing practices of pharmacy personnel, when dispensing a reliever inhaler, to the minimum requirements set out by the South African Pharmacy Council. The results of this study indicated that there was no adherence to the minimum requirements when dispensing a reliever inhaler.
- Full Text:
- Date Issued: 2019
- Authors: Gebers, Benjamin Herman Charles
- Date: 2019
- Subjects: Pharmacy -- Practice , Pharmaceutical services -- South Africa -- Eastern Cape Pharmaceutical services -- South Africa Western Cape Drug utilization Asthma
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/39752 , vital:35354
- Description: Short Acting Beta Agonist (SABA) inhalers in South Africa are available to patients without a prescription from an authorised prescriber. This study utilised a mystery shopping technique to observe, record and compare the dispensing practices of pharmacy personnel, when dispensing a reliever inhaler, to the minimum requirements set out by the South African Pharmacy Council. The results of this study indicated that there was no adherence to the minimum requirements when dispensing a reliever inhaler.
- Full Text:
- Date Issued: 2019
A proposed baseline South African antimicrobial stewardship curriculum for the Bachelor of Pharmacy programme
- Authors: Khan, Yasmine
- Date: 2019
- Subjects: Pharmacy -- Study and teaching -- South Africa , Pharmacy -- Practice -- South Africa Drug utilization -- Dissertations Drug utilization -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/35752 , vital:33805
- Description: Antimicrobial stewardship refers to the healthcare practice which ensures the judicious and appropriate prescribing of antimicrobial agents. The primary purpose of antimicrobial stewardship entails minimising the progression of antimicrobial resistance; the rise of which is recognised as a threat to global health and safety. The pharmacist is recognised nationally and internationally as a key role player in the implementation of antimicrobial stewardship. Education of healthcare practitioners in antimicrobial stewardship is a recognised strategic enabler for the containment of antimicrobial resistance in South Africa. The primary aim of the study was to develop a proposed baseline antimicrobial stewardship curriculum which is suitable for implementation into the Bachelor of Pharmacy programmes offered by South African schools of pharmacy. The aims and objectives of the study were achieved through the conduction of four study phases: the content analysis, academic review, expert consultation and curriculum development. The content analysis investigated the structure and content of international antimicrobial stewardship curricula, and the national policy governing antimicrobial stewardship implementation in South Africa. Frequency distributions of trends from the reviewed literature informed the development of the initial draft antimicrobial stewardship curriculum for pharmacy students. In terms of content, the principles which emerges with high frequency, which were thus emphasised in the initial draft curriculum, included: the strategic objectives (governance, surveillance, antimicrobial stewardship and infection prevention); strategic enablers (education, communication, legislation and research); dose optimisation; audit and feedback; formulary restriction; collaboration; pre-authorisation; and de-escalation. Available literature did not provide extensive detail regarding the curriculum structure utilised internationally, particularly with regards to the number of contact hours dedicated to the curriculum content and the year level at which antimicrobial stewardship was incorporated in the degree programme (variable between studies). From the content analysis it was evident that a mixed methods pedagogy and use of multiple assessment techniques were recommended. The academic review phase allowed for further insight to be obtained into the content and structure of antimicrobial stewardship curriculum content which was presented in the pre-existing Bachelor of Pharmacy degree programmes. Furthermore, the academic review required that nominated participants from each school of pharmacy indicate which antimicrobial prescribing principles should be incorporated in the proposed baseline antimicrobial stewardship curriculum. The results of the academic review phase were collated with the content analysis in order to develop the updated draft antimicrobial stewardship curriculum. It was interesting to note that large variation in content and structure related to antimicrobial stewardship which was presented by the various schools of pharmacy in South Africa. In terms of curriculum content, recommendations made by academic professionals informed the development of relative importance groupings, which allowed for the various antimicrobial stewardship principles to be tiered according to importance for inclusion in the proposed baseline antimicrobial stewardship curriculum. The large variation in antimicrobial stewardship curriculum structure posed as a challenge for the development of the proposed baseline curriculum, requiring that the structure remain flexible in order for feasible incorporation into the pre-existing Bachelor of Pharmacy degree programmes offered by the various schools of pharmacy in South Africa. The expert consultation phase explored the perceptions of multiple key health disciplines who serve as part of antimicrobial stewardship teams in South Africa with regards to the role of the pharmacist in antimicrobial stewardship; and the minimum level of antimicrobial stewardship knowledge and skills which pharmacy students should possess prior to entry into practice. The results of the expert consultation phase were collated with the results of the content analysis and academic review phase in order to develop the final proposed baseline antimicrobial stewardship curriculum. The findings of the expert consultation phase indicated great variability regarding the perceived role of the pharmacist in antimicrobial stewardship within and between health disciplines. Furthermore, the relative perceived importance of various antimicrobial stewardship strategies and antimicrobial prescribing principles were explored, which informed the tiering of content in the final proposed antimicrobial stewardship curriculum.
- Full Text:
- Date Issued: 2019
- Authors: Khan, Yasmine
- Date: 2019
- Subjects: Pharmacy -- Study and teaching -- South Africa , Pharmacy -- Practice -- South Africa Drug utilization -- Dissertations Drug utilization -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/35752 , vital:33805
- Description: Antimicrobial stewardship refers to the healthcare practice which ensures the judicious and appropriate prescribing of antimicrobial agents. The primary purpose of antimicrobial stewardship entails minimising the progression of antimicrobial resistance; the rise of which is recognised as a threat to global health and safety. The pharmacist is recognised nationally and internationally as a key role player in the implementation of antimicrobial stewardship. Education of healthcare practitioners in antimicrobial stewardship is a recognised strategic enabler for the containment of antimicrobial resistance in South Africa. The primary aim of the study was to develop a proposed baseline antimicrobial stewardship curriculum which is suitable for implementation into the Bachelor of Pharmacy programmes offered by South African schools of pharmacy. The aims and objectives of the study were achieved through the conduction of four study phases: the content analysis, academic review, expert consultation and curriculum development. The content analysis investigated the structure and content of international antimicrobial stewardship curricula, and the national policy governing antimicrobial stewardship implementation in South Africa. Frequency distributions of trends from the reviewed literature informed the development of the initial draft antimicrobial stewardship curriculum for pharmacy students. In terms of content, the principles which emerges with high frequency, which were thus emphasised in the initial draft curriculum, included: the strategic objectives (governance, surveillance, antimicrobial stewardship and infection prevention); strategic enablers (education, communication, legislation and research); dose optimisation; audit and feedback; formulary restriction; collaboration; pre-authorisation; and de-escalation. Available literature did not provide extensive detail regarding the curriculum structure utilised internationally, particularly with regards to the number of contact hours dedicated to the curriculum content and the year level at which antimicrobial stewardship was incorporated in the degree programme (variable between studies). From the content analysis it was evident that a mixed methods pedagogy and use of multiple assessment techniques were recommended. The academic review phase allowed for further insight to be obtained into the content and structure of antimicrobial stewardship curriculum content which was presented in the pre-existing Bachelor of Pharmacy degree programmes. Furthermore, the academic review required that nominated participants from each school of pharmacy indicate which antimicrobial prescribing principles should be incorporated in the proposed baseline antimicrobial stewardship curriculum. The results of the academic review phase were collated with the content analysis in order to develop the updated draft antimicrobial stewardship curriculum. It was interesting to note that large variation in content and structure related to antimicrobial stewardship which was presented by the various schools of pharmacy in South Africa. In terms of curriculum content, recommendations made by academic professionals informed the development of relative importance groupings, which allowed for the various antimicrobial stewardship principles to be tiered according to importance for inclusion in the proposed baseline antimicrobial stewardship curriculum. The large variation in antimicrobial stewardship curriculum structure posed as a challenge for the development of the proposed baseline curriculum, requiring that the structure remain flexible in order for feasible incorporation into the pre-existing Bachelor of Pharmacy degree programmes offered by the various schools of pharmacy in South Africa. The expert consultation phase explored the perceptions of multiple key health disciplines who serve as part of antimicrobial stewardship teams in South Africa with regards to the role of the pharmacist in antimicrobial stewardship; and the minimum level of antimicrobial stewardship knowledge and skills which pharmacy students should possess prior to entry into practice. The results of the expert consultation phase were collated with the results of the content analysis and academic review phase in order to develop the final proposed baseline antimicrobial stewardship curriculum. The findings of the expert consultation phase indicated great variability regarding the perceived role of the pharmacist in antimicrobial stewardship within and between health disciplines. Furthermore, the relative perceived importance of various antimicrobial stewardship strategies and antimicrobial prescribing principles were explored, which informed the tiering of content in the final proposed antimicrobial stewardship curriculum.
- Full Text:
- Date Issued: 2019
Simulated learning: integrating clinical knowledge into the dispensing process
- Authors: Klitsie, Monique
- Date: 2019
- Subjects: Medicine -- Study and teaching -- Simulation methods , Pharmacy -- Study and teaching Hospital pharmacies -- South Africa Pharmacy management -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/42239 , vital:36638
- Description: Pharmacy education has experienced a continual shift in the emphasis of the practice of pharmacy, requiring pharmacists to practice high levels of competence in performing the dispensing process while incorporating clinical knowledge using complex levels of cognitive skill. This highlights the need for opportunities within the learning environment which both require and facilitate the integration of clinical knowledge-based cognitive skills into the dispensing process. Simulation-based education has been demonstrated to assist in gradually increasing the level of complexity of tasks requiring performance by students in clinical settings. This study explored ways in which a computer-based dispensing program, MyDispense, could be used to facilitate the integration of clinical knowledge-based cognitive skills into the dispensing process. In the study, simulated patient scenarios for MyDispense were developed, which required the integration of a hierarchy of cognitive skills into the dispensing process. These were evaluated in order to assess the level of cognitive skills required to complete the clinical scenarios created. The developed MyDispense-based clinical scenarios were then piloted with a group of pharmacy students, after which a focus group was used to explore the students’ experience of the ability of MyDispense to integrate clinical knowledge into the dispensing process. This qualitative study adopted an exploratory approach in order to understand the potential benefit of computer-based simulated learning as a means of integrating clinical knowledge-based cognitive skills into the dispensing process. Purposive and convenience sampling was used in this study and data collection was through the completion of purpose-designed assessment forms by pharmacy lecturers and focus groups with student participants. Data from the assessment forms was used as feedback to further refine the clinical scenarios, and the focus group recording was transcribed and analysed using a thematic analysis approach. The scenarios assessed by the pharmacy lecturers were shown to require high levels of cognitive skills as described by Bloom’s Revised Taxonomy (Anderson & Krathwohl, 2001) and necessitated that the students plan, construct, design, and generate information to complete the scenarios. The pharmacy students successfully practiced the MyDispense scenarios as an adjunct to a clinical module and reported that the scenarios had assisted them in learning for the clinical module. The students acknowledged that they were required to apply their clinical knowledge and make clinical decisions while completing the scenarios. This study demonstrates that simulation-based education can be used as a beneficial educational tool for teaching the application of complex clinical knowledge-based cognitive skills to the dispensing process. It provides a valuable means of preparing students for professional work-based pharmacy practice.
- Full Text:
- Date Issued: 2019
- Authors: Klitsie, Monique
- Date: 2019
- Subjects: Medicine -- Study and teaching -- Simulation methods , Pharmacy -- Study and teaching Hospital pharmacies -- South Africa Pharmacy management -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/42239 , vital:36638
- Description: Pharmacy education has experienced a continual shift in the emphasis of the practice of pharmacy, requiring pharmacists to practice high levels of competence in performing the dispensing process while incorporating clinical knowledge using complex levels of cognitive skill. This highlights the need for opportunities within the learning environment which both require and facilitate the integration of clinical knowledge-based cognitive skills into the dispensing process. Simulation-based education has been demonstrated to assist in gradually increasing the level of complexity of tasks requiring performance by students in clinical settings. This study explored ways in which a computer-based dispensing program, MyDispense, could be used to facilitate the integration of clinical knowledge-based cognitive skills into the dispensing process. In the study, simulated patient scenarios for MyDispense were developed, which required the integration of a hierarchy of cognitive skills into the dispensing process. These were evaluated in order to assess the level of cognitive skills required to complete the clinical scenarios created. The developed MyDispense-based clinical scenarios were then piloted with a group of pharmacy students, after which a focus group was used to explore the students’ experience of the ability of MyDispense to integrate clinical knowledge into the dispensing process. This qualitative study adopted an exploratory approach in order to understand the potential benefit of computer-based simulated learning as a means of integrating clinical knowledge-based cognitive skills into the dispensing process. Purposive and convenience sampling was used in this study and data collection was through the completion of purpose-designed assessment forms by pharmacy lecturers and focus groups with student participants. Data from the assessment forms was used as feedback to further refine the clinical scenarios, and the focus group recording was transcribed and analysed using a thematic analysis approach. The scenarios assessed by the pharmacy lecturers were shown to require high levels of cognitive skills as described by Bloom’s Revised Taxonomy (Anderson & Krathwohl, 2001) and necessitated that the students plan, construct, design, and generate information to complete the scenarios. The pharmacy students successfully practiced the MyDispense scenarios as an adjunct to a clinical module and reported that the scenarios had assisted them in learning for the clinical module. The students acknowledged that they were required to apply their clinical knowledge and make clinical decisions while completing the scenarios. This study demonstrates that simulation-based education can be used as a beneficial educational tool for teaching the application of complex clinical knowledge-based cognitive skills to the dispensing process. It provides a valuable means of preparing students for professional work-based pharmacy practice.
- Full Text:
- Date Issued: 2019
Development of a framework for a proposed antimicrobial usage reporting tool for public sector hospitals
- Authors: Ramjan, Yumna
- Date: 2019
- Subjects: Anti-infective agents
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/43030 , vital:36727
- Description: Background: The inappropriate and unnecessary use of antimicrobials has increased the need to monitor antimicrobial usage so as to identify inappropriate use. In order to support the antimicrobial stewardship (AMS) programme, it is important to quantify the usage of antimicrobials and this can be achieved by promoting the use of AMS utilisation metrics. They are used to measure the progress and efficacy of an AMS programme (Brotherton, 2018).Primary Aim of Research: The primary aim of the research was to develop a framework for a proposed antimicrobial usage reporting tool, which would integrate with various data sources in order to be used by AMS practitioners to optimise antimicrobial usage in the South African public sector hospital setting.Methodology: The study was divided into three phases: a preliminary phase, a developmental phase and a post-developmental phase. The preliminary phase focused on obtaining a comprehensive understanding of the type and nature of the AMS utilisation metrics and subsequently identifying the views on the usage, usefulness and clinical relevance of those AMS utilisation metrics using a quantitative questionnaire, which was conducted among infectious disease specialists, pharmacists, medical prescribers, i.e. prescribers who were not specialists and clinical pathologists employed at tertiary level, public sector hospitals in the Eastern Cape province of South Africa. Consequently, a qualitative semi-structured interview was conducted among healthcare professionals who were involved in the daily implementation of AMS in the workplace. Results obtained from the quantitative component and qualitative component were integrated in order to develop a framework for a proposed antimicrobial usage reporting tool. Results: The Defined Daily Dose (DDD), Prescribed Daily Dose (PDD) and Days of Therapy (DOT) were identified as the most common AMS metrics (Grau et al., 2013). However, the DDD was the only AMS metric currently recommended by the South African National Department of Health (South African National Department of Health, 2017a)and it was the only AMS metric currently being utilised at two of the five research sites in the Eastern Cape province of South Africa. It was identified that data pertaining to antimicrobial usage was available and was being extracted from Rx Solution®. However, the programme did not have the ability of automatically producing the reports, hence, emphasising on the need for an antimicrobial usage reporting tool for South African public sector hospitals. Therefore, the framework for the proposed antimicrobial usage reporting tool would integrate antimicrobial stock management data with the following AMS utilisation metrics: DDD, DOT and PDD, were considered for inclusion in the proposed antimicrobial usage reporting tool. Conclusion: The qualitative findings obtained during the post-developmental phase, therefore, established that although an electronic platform for the purpose of monitoring antimicrobial usage for the South African public sector hospitals was required, there would be many challenges obstructing the implementation of the proposed antimicrobial usage reporting tool.
- Full Text:
- Date Issued: 2019
- Authors: Ramjan, Yumna
- Date: 2019
- Subjects: Anti-infective agents
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/43030 , vital:36727
- Description: Background: The inappropriate and unnecessary use of antimicrobials has increased the need to monitor antimicrobial usage so as to identify inappropriate use. In order to support the antimicrobial stewardship (AMS) programme, it is important to quantify the usage of antimicrobials and this can be achieved by promoting the use of AMS utilisation metrics. They are used to measure the progress and efficacy of an AMS programme (Brotherton, 2018).Primary Aim of Research: The primary aim of the research was to develop a framework for a proposed antimicrobial usage reporting tool, which would integrate with various data sources in order to be used by AMS practitioners to optimise antimicrobial usage in the South African public sector hospital setting.Methodology: The study was divided into three phases: a preliminary phase, a developmental phase and a post-developmental phase. The preliminary phase focused on obtaining a comprehensive understanding of the type and nature of the AMS utilisation metrics and subsequently identifying the views on the usage, usefulness and clinical relevance of those AMS utilisation metrics using a quantitative questionnaire, which was conducted among infectious disease specialists, pharmacists, medical prescribers, i.e. prescribers who were not specialists and clinical pathologists employed at tertiary level, public sector hospitals in the Eastern Cape province of South Africa. Consequently, a qualitative semi-structured interview was conducted among healthcare professionals who were involved in the daily implementation of AMS in the workplace. Results obtained from the quantitative component and qualitative component were integrated in order to develop a framework for a proposed antimicrobial usage reporting tool. Results: The Defined Daily Dose (DDD), Prescribed Daily Dose (PDD) and Days of Therapy (DOT) were identified as the most common AMS metrics (Grau et al., 2013). However, the DDD was the only AMS metric currently recommended by the South African National Department of Health (South African National Department of Health, 2017a)and it was the only AMS metric currently being utilised at two of the five research sites in the Eastern Cape province of South Africa. It was identified that data pertaining to antimicrobial usage was available and was being extracted from Rx Solution®. However, the programme did not have the ability of automatically producing the reports, hence, emphasising on the need for an antimicrobial usage reporting tool for South African public sector hospitals. Therefore, the framework for the proposed antimicrobial usage reporting tool would integrate antimicrobial stock management data with the following AMS utilisation metrics: DDD, DOT and PDD, were considered for inclusion in the proposed antimicrobial usage reporting tool. Conclusion: The qualitative findings obtained during the post-developmental phase, therefore, established that although an electronic platform for the purpose of monitoring antimicrobial usage for the South African public sector hospitals was required, there would be many challenges obstructing the implementation of the proposed antimicrobial usage reporting tool.
- Full Text:
- Date Issued: 2019
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