The Antimicrobial Stewardship Program is an integral A Look Back: component of our safety and quality agenda, and keeps Milestone Achievements of the our patients safe. I am proud to know that this group has SHS-UHN Antimicrobial Stewardship Program provided leadership across the province, country and • Antimicrobial Stewardship Program (ASP) is launched internationally in this area.” in the Mount Sinai Intensive Care Unit (ICU) with Audit and Feedback- a process whereby an Dr. Maureen Shandling, Executive Vice ASP Pharmacist/MD meets with the clinical team President, Academic & Medical Affairs and together they review the antibiotics patients are receiving so as to optimize their use. • Reducing infection in C-section. An initiative to ensure The Antimicrobial Stewardship patients are getting appropriate antimicrobials at 2009 the right time in order to reduce post-op C-section Program’s development infections. of individualized physician • ASP launched at University Health Network in ICU and antibiotic usage profiles is truly Outpatient Antimicrobial Treatment trial launched, Audit transformative. For the first and Feedback in the ICU and ensuring patients being transitioned home on antibiotics are receiving proper time, our doctors have data follow-up. • Antimicrobial Stewardship Program is launched at on the quantity and type of Princess Margaret with Audit and Feedback. antibiotics they are using.” • Mount Sinai Hospital and University Health 2010 Dr. Peter Cram, Director of the Division of Network’s Antimicrobial Stewardship Programs General Internal Medicine and Geriatrics at merge. and University Health Network • antimicrobialstewardship.com is launched to offer resources to both health care providers and patients. • Antimicrobial Stewardship Program offers and hosts the Over the past 10 years, the first national course on antimicrobial stewardship. ASP has become a vital part of • Council of Academic of (CAHO) the General Internal Medicine 2011 program Advancing Research to Improve Care (ARTIC) awards the ASP with a grant to assist academic hospitals enterprise. The scheduled across Ontario to develop similar ASPs in their ICUs. rounds with the ASP pharmacist • ASP initiative for General Internal Medicine begins with have made me a better internist, audit and feedback for prescribers and other clinicians. and I now routinely incorporate what I have learned from ASP • The ASP develops Best Practices and Algorithms for the management of common infections. material and personnel into how • The ASP names their first clinical research fellow. I practice medicine and what • Accreditation Canada adds antimicrobial 2012 I teach medical students and stewardship programs to its list of required residents.” organizational practices. Dr. David Frost, General Internal Medicine Site Director, Western Hospital

• ASP develops their first three-year strategic plan. • Antimicrobial stewardship course, developed by a member of the ASP, is offered at . The work of the ASP program 2013 It remains the only undergraduate antimicrobial has been very helpful in guiding • Success of the ARTIC initiative in academic stewardship course in the country. the care of infectious diseases hospitals results in another grant being awarded to • SHS-UHN ASP develops and delivers second national in the Emergency Department. the ASP - ARTIC CHILL - to assist the development course on antimicrobial stewardship. of ASPs in community hospitals across Ontario. A standardized, evidence- • The first ASP registered nurse position in Canada based, rational approach to is created. the management of common • In working to improve how hospitals deal with conditions like skin and soft sepsis, the Sepsis Now a Priority (SNAP) algorithm tissue infections has both to assess and treat at-risk patients was implemented in Mount Sinai’s Emergency Department. 2014 significantly improved patient • ASP launches the CLiP application and clinician tool. care while at the same time • ASP develops, implements and disseminates High reducing costs. It’s an amazing Risk Febrile Neutropenia protocol. Cancer Care achievement!” Ontario further assists in the dissemination of • Antimicrobial Stewardship Program is launched in the the protocol to ensure continuity of care and Multi-Organ Transplant Program at UHN with Audit and Dr. Bjug Borgundvaag, Director of the protection of immune-suppressed patients in their Feedback. Schwartz/Reisman Emergency Medicine Institute at Sinai Health System community hospitals. • In partnership with Accreditation Canada, ASP creates an antimicrobial stewardship course, specifically to 2015 assist hospitals through the accreditation process. • Sinai Health System and University Health Network ASP I completed an elective with co-host the Pan-Canadian Antimicrobial Resistance ASP as a trainee and the Round Table with HealthcareCAN. • ASP is visited by Canada’s Chief Public Health experience of working with Officer, Federal Deputy Minister of Health, and the Public Health Agency’s CEO. an interdisciplinary team was • ASP develops physician-specific reports, allowing profoundly influential. The for more specific feedback on prescribing knowledge I gathered with the antimicrobials to patients. 2016 ASP team has had a strong • ASP creates nursing interventions aimed at impact on my practice as an reducing antimicrobial use in asymptomatic bacteriuria (, Toronto attending physician in the ICU.” Western Hospital and Toronto Rehabilitation • Development and launch of Multi-Organ Transplant Best Dr. Ian Randall, Anesthesiology and Critical Institute). Care Medicine, Department of Anesthesia Practice Guidelines for infections. and Pain Management, University Health • Launch of JEDI (Judicious Evaluation of antimicrobial Network Decision-making in the ICU) and SABR (Stewardship At Bedside Rounds) in the ICUs at UHN and Mount 2017 Sinai Hospital, with the aim of returning antimicrobial stewardship to the bedside while improving nursing We’ve learned that antimicrobial engagement. stewardship is as much a • Visit from Federal Minister of Health, the Hon. Jane community matter as it a Philpott. hospital one, perhaps even • ASP develops a patient-centred video to educate more so. Efforts to ensure about antibiotic use. appropriate use of antibiotics • Community ASP initiative launched with Ministry of Health and Long Term Care. in primary care, like the • New ASP website 2.0 launched. 2018 work undertaken by the • ASP and Michener Critical Care Nursing Program Antimicrobial Stewardship curriculum launched. Program, has the potential to significantly impact the future availability of safe and effective antibiotics.”

Dr. David Tannenbaum, Family Physician- in-Chief of the Ray D. Wolfe Department of Family Medicine at Mount Sinai Hospital and Lead Physician of the Mount Sinai Academic Family Health Team