Dr. Shaqil Peermohamed is using a cellphone app to disseminate information on the antimicrobial stewardship program to the province’s physicians
By Girard Hengen
Innovative physicians like Saskatoon’s Dr. Shaqil Peermohamed are tapping into the potential of the ubiquitous cellphone to improve patient care in ways that were unimaginable just a few years ago.
Dr. Peermohamed is the physician lead of the antimicrobial stewardship program in Saskatoon. When he started in his position in 2016, he and the program’s pharmacy lead, Justin Kosar, were a small operation with big plans. One of the biggest challenges they faced was how to get the latest information on managing infections – tailored with local antibiotic resistance patterns – to physicians across Saskatchewan to prevent unnecessary or inappropriate usage.
“With our program’s limited resources, we needed an innovative medium to effectively generate and disseminate current, evidence-based information for health-care professionals,” Dr. Peermohamed told the SMA.
Traditionally, physicians have used pre-printed order sets or paper pocket guides that specified – in print – which tests to order or which antibiotics to use for various infections.
“The concern with using pre-printed order sets in health care is this concept of muda, which is a Japanese word for waste in terms of quality of care,” said Dr. Peermohamed. “If we see a change in local antibiotic resistance patterns in our hospital or community, we need to be able to quickly adapt and adjust our antibiotic recommendations to our physicians and pharmacists. With pre-printed order sets, how do you quickly make a new order set, how do you get rid of the old one, and how do you ensure that no one is referring to that old one anymore?
“That’s where the power of technology lies – because if we use an app and can ensure that the information is updated automatically, we can eliminate muda and we can ensure that clinicians have evidence-based information that’s up to date based upon local resistance patterns. This could essentially change prescribing patterns in Saskatchewan to help physicians and pharmacists make the best decision for their patients.”
Spectrum is an app developed by two medical residents in Calgary who worked with software developers and teams from the University of Calgary and Alberta Health Services. Spectrum can be customized to provide local antimicrobial stewardship resources in any hospital. It can be used at the point of contact with patients, giving physicians evidence based guidelines, antimicrobial information that incorporates local resistance patterns and updated antimicrobial formulary content.
“We had already seen several success stories following the implementation of their app, so we wanted to bring this to Saskatchewan,” said Dr. Peermohamed.
Spectrum was launched in Saskatoon on April 12, 2018, and made available for free to all health-care professionals through a University of Saskatchewan College of Medicine research award. More than 500 people downloaded Spectrum in the first week, and it currently has more than 800 active users. In November 2018, Spectrum content was accessed more than 2,400 times.
Physicians, pharmacists, residents, nurses and medical students are the most common users, and the most popular clinical pathways reflect common community-acquired infections. The average user spends two minutes, 42 seconds accessing content, which Dr. Peermohamed says indicates clinicians are rapidly accessing relevant information. While the highest usage is in Saskatoon, Spectrum hits have been tracked to Regina, North Battleford, Prince Albert, Moose Jaw and Swift Current.
After nine months of use on Royal University Hospital medical units, total antimicrobial use and anti-pseudomonal antimicrobial use were down 25 per cent and 35 per cent respectively. Dr. Peermohamed says this likely reflects “improved guideline adherence and appropriateness of antimicrobial prescribing.”
Some of Spectrum’s success is attributed to the developers engaging specialists when they created content for the app. They asked physicians what information would be most helpful and which infections they are most commonly seeing. This input helped the developers tailor the app so it is most beneficial for front-line prescribers of antibiotics. Dr. Peermohamed said a current push is to encourage more family physicians to use Spectrum and optimize prescribing patterns in community settings.
Dr. Peermohamed emphasizes the success of Saskatoon’s antimicrobial stewardship program has been a collaborative effort involving many stakeholders, including clinicians and specialists, microbiology staff, administrators and senior leaders in pharmacy administration. All saw the need to prioritize principles of antimicrobial stewardship.
We wanted to engage clinicians with an easy and simple platform to navigate and access information,” he said. “The impetus certainly was the fact that we see high rates of inappropriate prescribing, and that’s not just in Saskatchewan, that’s an international problem.
Dr. Peermohamed concludes that, although some of the major issues in treatment and care have persisted for years, technological developments harnessing the power of a cellphone through an app provide never-imagined opportunities for physicians to address these issues and provide better care for their patients.
“I think back to when I was in medical school and if I had a question regarding what antibiotics to give to a patient, I would have to spend a decent amount of time – and interrupt my work flow – to access guidelines and other resources, and then reflect upon local resistance patterns,” said Dr. Peermohamed.
However, by centralizing evidence-based guidelines and integrating local resistance patterns into one central platform that’s easy to access and navigate at the patient’s bedside, I believe this improves clinician workflow and efficiency so they can then spend more time at the bedside with their patients. ◆