CwPAMS 1.5 UK-Sierra Leone Partnership
The partnership focused on Institutionalising Antimicrobial Stewardship (AMS) at Connaught Hospital.
Lead partners of the CwPAMS 1.5 UK-Sierra Leone Partnership consisted of:
King’s Global Health Partnerships, King’s College London; and
Connaught Hospital, University of Sierra Leone Teaching Hospital Complex
The partnership focused on Institutionalising Antimicrobial Stewardship (AMS) at Connaught Hospital.
There were two streams within the project:
1. Establishment of an AMS sub-committee at Connaught Hospital to lead on activities including:
– Creation of three-year action plan focussing on AMS
– Awareness raising among hospital staff
– Review of surgical prophylaxis guidelines
2. Delivery of an accredited training programme within Connaught Hospital for 10 early-career pharmacists to enable them to become AMS champions
Global Point Prevalence Surveys (GPPS) data was entered electronically on tablets enabling quick access to hospital report and comparative data. Findings highlighted a high usage of antimicrobials in all areas when compared to the rest of the African continent. A need to raise awareness about AMS and antimicrobial guidelines was also identified and incorporated into Sierra Leone’s action plan, alongside the need to review existing guidelines with consultant involvement. In addition, with no microbiology laboratory services in the country, it was reported that all prescribing decisions were currently empirical, making antimicrobial stewardship a high priority and amplifying the need to improve prescribing practices such as documentation of indication and duration as well as review dates.
Sierra Leone’s first hospital AMS committee and action plan were established, and activities were aligned to strategic objectives in the national plan. It was reported that the AMS training was highly valued by their pharmacists.
AMS Champions
10 early career pharmacists with a range of backgrounds applied to participate in the Sierra Leone AMS Champions programme. Training was conducted at Connaught Hospital once a week (20 days total). Blended learning online and in-person was used with specialists from King’s Health Partnerships, Connaught Hospital and . Ward visits, case discussions, GPPS and community awareness raising also formed part of the programme.
ALL champions reported that they had been able to influence members of the public or patients. One champion said, “A lady came into the pharmacy where I work to buy Ampiclox without a prescription. I asked her why she needed it and she explained she takes it every month after seeing her period. I talked to her about antimicrobial resistance and described what will happen if she continues taking antibiotics without a doctor’s prescription. She was happy with the conversation and promised not to misuse antibiotics again.”
The Champions also organised a community awareness-raising activity. As many drug peddlers sell antibiotics on public transport, paying the drivers to allow them to pitch, the pharmacists targeted the same public audience to share their own messages about safe and rational antibiotic use.
Future plans include:
- Provide ongoing support for Connaught committee members to further establish AMS at the hospital
- Build on existing Connaught guidelines to develop national guidelines
- Replicate these activities in other hospitals across Sierra Leone, utilising new AMS Champions where possible
- Utilise AMS Champions in sharing learning with other pharmacists (CPD)
- Develop training to encompass specific needs from other pharmacy settings e.g. community / administrative
- Consider how a course could be developed for other professional groups (e.g. junior doctors) or in undergraduate programmes
“At Connaught, I was able to interact with doctors with regard to their prescriptions. Most of them were not aware of the treatment guidelines. Some are not complying. I was also able to interact with nurses with regard to missing documentation on the patient treatment record. At 34 military hospitals, my (regular) workplace, I was able to conduct the first-ever Global PPS involving other workers at the hospital.”
