MD Antimicrobial Stewardship Focal Point

Role summary Lead an antimicrobial stewardship (AMS) program in a medical or surgical humanitarian hospital. Médecins Sans Frontières (MSF) / Doctors Without Borders has increased its focus on the problem of antibiotic resistance. Antimicrobial resistance (AMR) is growing rapidly in low and middle-income countries and MSF faces ongoing challenges managing antibiotic resistant infections in hospitalized patients particularly in patients with burns, trauma, hospital infections and in pediatric and neonatal care. AMR threatens patient outcomes, makes hospitals less safe and increases costs. MSF is committed to responding and one part of this response is to increase efforts to conserve the effectiveness of antibiotics through antibiotic stewardship. Duties and responsibilities Leading, promoting and supporting antimicrobial stewardship efforts in the healthcare facility(s) across the spectrum of healthcare. Establish and participate in a multidisciplinary AS committee (that meets regularly with Terms of Reference). Identify antimicrobial stewardship priorities together with the AS committee and the mission. Monitor, collect and analyze the antimicrobial data reported to the multidisciplinary AS committee. Conduct regular audits relevant to stewardship priorities. This might include audits of antibiotic use, treatment of select conditions, indications for microbiology testing, and communication of results. Provide feedback to the project and the mission regarding results of audits and plan improvements. Co-ordinate and deliver education to other medical, nursing and pharmacy staff around stewardship. Support other clinical staff regarding antibiotic choices and regularly participate in clinical rounds. Liaise with the laboratory for timely communication of results (where relevant), interpretation of results and feedback to clinicians. Collaborate with lab + IPC to prospectively monitor pathogens of concern and respond to hospital outbreaks including outbreaks of multidrug resistant organisms/bacteria (MDRO). Identify opportunities to improve stewardship in the project (e.g., therapeutic drug monitoring, OPAT). Participate in relevant project level committees (e.g., IPC, Quality improvement, Morbidity + Mortality reviews). In collaboration with IPC and the clinical team, participate in detection, management and prevention of healthcare associated infections. MSF Section/Context Specific Accountabilities • Apply medical knowledge and skills to diagnose and prevention. Carry out outpatient and inpatient consultations, prescribing the necessary treatment respecting MSF protocols. • Keep the patient and/or his/her family informed about the illness and provide appropriate explanations about the treatment to follow, checking they have understood. • Follow up the evolution of the hospitalized/IDP patients, through daily visits, consultations, and examinations, prescribing the necessary treatment following MSF protocols, deciding whether they can be discharged or transferred to other departments – in collaboration with other doctors- and informing their family about the patient’s evolution. • Check and control the rational distribution of medicines and equipment under his/her responsibility and take care the quality, disinfection, and sterilization of the medical material. Assure général compliance with standing hygiène standards. • Participate in the collection and analysis of epidemiological data, checking its validity and informing the line manager or project coordinator about any problem or complication of the patient’s illness, medical error and monitors the proper functioning of the department, equipment, or material. • Ensure ongoing training of the medical/paramedical multidisciplinary team to optimize the quality of care. • Knows and ensures all MSF medical protocols are followed and implemented, checking universal precautions are always followed and reducing bio-hazard risks and improving infection control. Ensures professional confidentiality is respected. • Manage the team under his/her direct responsibility according to MSF HR policies and procedures, supervising their performance, organizing, and scheduling shifts and rotations, directly participating in emergencies and on calls if necessary. • Regularly monitor through chart and prescription review adherence to MSF protocols in terms of antimicrobial use in the departments and share feedback to the prescriber if noticing any deviation from the protocol. • Regularly perform prescription audit, Point Prevalence survey, and other antibiotic surveys and feedback to the team regarding the results of the audit. • Attend daily ward rounds, work in close collaboration with the chief of the wards and engage them in antimicrobial stewardship activities, support other clinical staff regarding antibiotic choices to improve their prescribing behaviour. • Ensure the availability of updated guidelines in the different departments. • Drafts, reviews, and follows the implementation of antibiotics guidelines (MSF or MOH), protocols, SOPs, and tools according to the needs of the project. • Identify training needs in the departments related to antimicrobial use and share with Line manager. • Conduct training sessions on basics concepts of microbiology, antimicrobial resistance and antibiotic treatment and follow-up the didactic trainings through bedside coaching, AMS ward rounds and clinical case discussions for prescribers, pharmacists, and nurses. • Work in collaboration with the IPC supervisor to enhance IPC measures as part of the AMR pillars. • Participate in the IPC committee and emphasize the importance of adherence to IPC measures. • Collaborate with lab + IPC to prospectively monitor pathogens of concern and respond to hospital outbreaks including outbreaks of multidrug resistant organisms/bacteria (MDRO). • Participate in the collection and analysis of epidemiological data, checking its validity and informing the line manager or project coordinator about any problem or complication of the patient's illness, medical error, and monitoring the proper functioning of the department, equipment, or material. • Knows and ensures all MSF medical protocols are followed and implemented, checking that universal precautions are always followed and reducing bio-hazard risks and improving infection control. Ensures professional confidentiality is respected. • Give regular feedback to the line manager and report directly any issue or incident. • Flexible to perform additional work-related tasks requested by the Line manager or Functional manager. Job requirements Minimum Requirements and Competencies Education Essential : - Medical degree from an agreed university/college - Specialization in Paediatrics, Infectious Diseases, Internal medicine or Family medicine Desirable: - Completed on-line training in antimicrobial stewardship [e.g. BSAC (British Society of Antimicrobial Chemotherapy) and/or WHO (World Health Organisation) Experience Essential: - At least 5 years’ experience in working as a medical doctor in inpatient settings. Desirable: - Experience in reviewing medical records/reviewing appropriateness of antimicrobials. Working experience in MSF or other NGOs in a similar position Languages AMC Card Essential: - Dari/Pashtu: oral and written - English: oral and written Essential: - Valid AMC Card Knowledge Essential : • Have a working understanding of key pathogens, their usual antibiotic susceptibilities, typical clinical presentations, and empiric or targeted treatment. • Have a working understanding of the modes of action of antimicrobials including their spectrum of activity. • Have a working understanding of the key principles of infection prevention and control (IPC) and the relationship between IPC and AMR Antimicrobial Resistance). • Have a working understanding of the appropriate use of antimicrobials to prevent the emergence of resistance and avoidance of adverse effects. • Have a working understanding of the use of diagnostic tests in the investigation and management of infectious diseases. How to use data for feedback and reportant. • Computer literacy – word and excel. Desirable: • Understanding of behaviour change principles. • Able to provide face to face feedback to prescribers about antibiotic prescriptions. Competencies • People management • Commitment • Flexibility • Results • Analytical thinking • Planning and organization • Teamwork