Enhancing antimicrobial surveillance
The United Arab Emirates’ Ministry of Health (UAE MoH) revolutionizes the quality, safety and efficiency of public health care delivery at all 15 public hospitals and more than 86 affiliated clinics across Dubai and the Northern Emirates.
The UAE MoH launched the Wareed project in 2008 to pursue a ‘one patient, one record’ initiative by deploying Cerner Millennium® as the core application. The architecture links all clinical, operational and administrative data into a unified system.
In 2015, the UAE MoH launched an online patient portal, a fully integrated bilingual website allowing individuals access to their health record and direct communication with the Ministry’s health care providers. Each patient’s clinical information is stored in Millennium and can be securely accessed by individuals via a browser or smart phone.
Antimicrobial resistance is an ongoing challenge across the world, compromising our ability to treat infectious diseases, as well as undermining many other advances in health and medicine. At the 68th World Health Assembly in May 2015, the body endorsed a global action plan to tackle antimicrobial resistance - including antibiotic resistance, the most urgent drug-resistant trend. One of the five strategic objectives of the global action plan sets is to strengthen the knowledge through surveillance and research.
UAE health leaders committed at the meeting to develop and implement a UAE National Action Plan on Antimicrobial Resistance by 2017. As part of UAE’s AMR surveillance action plan, AMR data collection from the MoH hospital network and surveillance report generation was a critical task and needed an electronic method of data collection and analysis.
Prior to the microbial susceptibility interface implementation and solution optimization, there was no substantial and reliable surveillance data available. The solution needed few optimizations to discretely result each antimicrobial resistance result accurately in Wareed. Due to these challenges, there was not enough electronic data to calculate antibiotic resistance rates for MoH.
Wareed optimization included addition of new susceptibility panels, microorganisms, and result responses for accurate resulting of the anti-microbial resistance results. All devices across MOH that were performing the antibiotic resistance testing were integrated with the Wareed system so as to ensure the susceptibility results are electronically available for statistics and analysis. A report was developed for retrieving the susceptibility results for eight pathogens against some antibiotics and then resistance rates (%R, n) were calculated.
The Cerner medical device interface reformats data supplied by devices into a common internal structure required by Cerner application servers. This handles both the download of orders, patient demographics to the device and uploading the results to the Cerner/Wareed system. All susceptibility results from the devices are automatically inserted into the system for verification and other departmental activities prior to making results available for publication. This process has eliminated manual human intervention while entering results manually to the system resulting in patient safety and improved care.
Prior to implementation, antibiotic resistance data was manually calculated with a lot of effort and data was minimal without actual estimates. Apart from the UAE national committee, the Microbiology department plans to share the resistance comprehensive data with pharmacy and physician committees for the antibiotic stewardship program.
A sample study for most common antibiotic panels (GP75, ST01, N222, N291 and XN05) was undertaken to evaluate the time spent on susceptibility testing pre- and post-implementation. Before the implementation of the project, an average of 41.75 seconds was spent by microbiology technologists to register a patient on the device and a substantial time of 187.45 seconds was spent entering the values and interpretations for the organism. With complete interface and solution optimization, the total time has come down to an average of 5 seconds per panel saving an average of 3.5 minutes per test. So, the actual time saved for 2,000 panel tests per month in a single MoH laboratory is approximately 6,000 minutes per month per laboratory.
This notable saving in time for the lab is a significant improvement for patients. The number of AMR results available electronically for microbial resistance surveillance has gone up by 35 percent for most of the microbiology laboratories.