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1. CITY OF CANDON HOSPITAL AMS Committee & Team Composition

2. AMS Committee Composition Head: Dr. Archimedes Mercado – Chief of Hospital Members: Dr. Roland Zara – Infection Prevention and Control Committee Dr. Angel Trinidad – Drugs and Therapeutic Committee Juvenal Racca , RN – Patient Safety Committee Dr. Brenda Rosuman – Head Pathologist Elizabeth Garabiles - IT/HIS

3. AMS TEAM Composition Rebecca Briones RPh – Chief Pharmacist Dr. Angel Trinidad – Antimicrobial Prescriber/Chief of Clinics Gevin Soriano RN – Infection Control Nurse Vernice Serrano RMT – Microbiologist Dr. Roland Zara – Infectious Disease MD

4. CHALLENGES EXPECTED

5. Manpower Insufficiency – Not enough trained Personnel (Clinical Pharmacist) Lack of Resources in starting the program. Resistance Drafting an AMS Policies and Procedures

6. STRATEGIES DEVELOPED TO ADDRESS CHALLENGES

7. Training and continuing education for members of the AMS Program. Education is the foundation in starting any program. Acquiring knowledge is important in realization of an effective AMS Program. Resources – address the problem to the Chief of Hospital in dedicating sufficient funding and resources in order for the program start.

8. Good Communication Structure. By collaborating with members of the team and other members of the organization affected in the implementation of the program by creating awareness. Accept any suggestions or ideas that may be helpful in starting the AMS Program. Meeting with members of the Team and Committee in drafting a workable AMS Policies and Procedures which are evidenced based (antibiogram, mostly used antimicrobial, clinical presentations, patient preferences and limited resources).

9. ACTION PLAN

10. ELEMENT ACTIONS BUDGET RESOURCES ESTIMATED TIME/DUE DATE MEASUREMENT 1. Leadership Relay to the top officials of the institution regarding the relevant information disseminated during the conduct of the seminar on Antimicrobial Stewardship Program in Hospitals Collaborate with the top officials to tap support from them in the planning, funding, and implementation of the AMS program in the City of Candon Hospital. 10, 000 Attendees of the seminar on Antimicrobial Stewardship Program in Hospitals   Medical Director   Supervisors   Heads of Department   AMS Committee   AMS Team until December 2018 CCH action plan on AMR briefer and presentation Element 1: LEADERSHIP

11. ELEMENT ACTIONS BUDGET RESOURCES ESTIMATED TIME/DUE DATE MEASUREMENT Disseminate derived plans to the Medical Director, Supervisors, and Heads of the Department to determine the lacking which are needed to be complied for such as the hiring of clinical pharmacist and IT specialist to the complete the AMS team Create Antimicrobial AMS committee /team subject for approval of top officials continuation…

12. ELEMENT ACTIONS BUDGET RESOURCES ESTIMATED TIME/DUE DATE MEASUREMENT 2. Policies and Guidelines Draft policies and guidelines for the AMS program to be participated with the AMS Committee and Team   Finalization of the Policies and Guidelines subject for the approval of the top officials 5,000 Medical Director   Supervisors   Heads of Department   AMS Committee   AMS Team January-May 2019 Approved policies and guidelines and agreement Element 2: POLICIES & GUIDELINES

13. ELEMENT ACTIONS BUDGET RESOURCES ESTIMATED TIME/DUE DATE MEASUREMENT 3. Surveillance of Antimicrobial Use (AMU)   and   Antimicrobial Resistance (AMR) Design a plan with regard to ensuring regular antimicrobial use monitoring to be reported annually by the AMS committee/team --the hospital management shall strengthen the capacity for laboratory surveillance that allow monitoring of antimicrobial susceptibility patterns and detection of resistant pathogens, and the hospital shall develop institutional antibiograms. 30,000 Medical Director   Supervisors   Heads of Department   AMS Committee   AMS Team 2018           2019 Approved project funding agreement Element 3: SURVEILLANCE OF AMU & AMR

14. ELEMENT ACTIONS BUDGET RESOURCES ESTIMATED TIME/DUE DATE MEASUREMENT 4. Action Perform the following: Action 1 : Antimicrobial Restriction and Pre-authorization. Clinicians are required to obtain approval for use of selected antimicrobials before prescribing. Action 2 : Seventh-day automatic stop order. Infections shall be treated with the shortest effective treatment duration 50,000 Medical Director   Supervisors   Heads of Department   AMS Committee   AMS Team 2018 Design for upgrading of laboratories for AMR and drug residue testing Element 4: ACTION

15. ELEMENT ACTIONS BUDGET RESOURCES ESTIMATED TIME/DUE DATE MEASUREMENT Action 3 : Point of Care Interventions. It includes those optimizations, streamlining, or the escalation of the antimicrobial therapy and intravenous to oral antimicrobial therapy switch. Action 4 : Respective Audit of antimicrobial prescribing and direct intervention and feedback continuation…

16. ELEMENT ACTIONS BUDGET RESOURCES ESTIMATED TIME/DUE DATE MEASUREMENT 5. Education Send healthcare staffs who are in contact with patients on antibiotics to clinical trainings and seminars related to AMS in pursuance of continuous education to gain competency on the said field 30,000 Medical Director   Supervisors   Heads of Department   AMS Committee   AMS Team 2018 Workshop conducted; disseminated on the implementation of relevant proper use of AMS Element 5: EDUCATION

17. ELEMENT ACTIONS BUDGET RESOURCES ESTIMATED TIME/DUE DATE MEASUREMENT 6. Performance Evaluation The AMS committee of City of Candon Hospital will prepare and submit to the DOH pharmaceutical division an annual AMS program monitoring report for tracking of progress of the AMS program. 5,000 AMS Committee   AMS Team 2020 Monitoring and submission of reports annually Element 6: PERFORMANCE EVALUATION