Pharmacy students help solve real-world health care challenge in Northern Ontario

Timmins and District Hospital Pharmacist Natalie Torres and 2T6 PharmD Student Andrea Elia

Students presented ideas to launch antimicrobial stewardship program in Northern Ontario to hospital management

In the summer of 2024, Andrea Elia (2T6) was working a short-term contract in the pharmacy department of Timmins and District Hospital. Her supervisor tasked her with exploring strategies the hospital could implement to launch an antimicrobial stewardship program, in collaboration with clinical pharmacist Sandy Solomon. This request was the beginning of an initiative that brought together pharmacists, pharmacy students and hospital management to look at innovative solutions for an important health care problem.

“I enjoyed knowing there was real-world impact to the project, that it would be utilized or implemented in some way. That made it scary, but also very rewarding,” says Elia, currently in her final year of the Doctor of Pharmacy (PharmD) program at U of T’s Leslie Dan Faculty of Pharmacy. “I think that when I look back on my PharmD degree, this project will be one of the things I will remember because of the integration between the class and the real world.”

“I think that when I look back on my PharmD degree, this project will be one of the things I will remember because of the integration between the class and the real world.”

Antimicrobial resistance is becoming one of the key challenges in health care. Resistant infections have fewer or less effective treatment options, so patients are at higher risk of more severe, longer-lasting and complicated infections, and even death. Routine surgeries and chemotherapy, which rely on antibiotics to prevent infections, become riskier. In fact, a 2024 study published in The Lancet estimated that more than 1 million people globally die each year due to antimicrobial resistance – approximately the same number of people who die from tuberculosis.  

To help address this challenge, pharmacists are taking on key roles in antimicrobial stewardship programs, which promote the optimal and appropriate use of antimicrobials to reduce resistance and improve patient outcomes. Many hospitals are implementing such programs, though the specifics can differ between hospitals based on local resources and capacity.

Solomon says that Timmins and District Hospital, located about 300 kilometres north of Sudbury has faced significant challenges with developing an antimicrobial stewardship program, partly due to challenges with having enough staff for pharmacists to take on extra projects on top of their clinical duties. She asked Elia to look into antimicrobial stewardship programs that similar-sized hospitals had implemented to get ideas on how they could start implementing their own program.

 Knowing that she would be taking the Introduction to Antimicrobial Stewardship (PHM383) course in the fall, Elia reached out to Mark McIntyre, the course’s coordinator and manager of the Sinai Health Antimicrobial Stewardship Program, for his insight. With this question, McIntyre saw an opportunity for the students in the course to work on a project with real-world impact.

Presenting to hospital management was ‘scary’ but gratifying

McIntyre typically included case studies for students to develop antimicrobial stewardship programs as part of the PHM383 course, but he soon began working closely with Solomon and the Timmins hospital management to develop a project that would help them advance their antimicrobial stewardship program.

“Antimicrobial stewardship in Canada really depends on the culture and resources of individual hospitals, so you can't do it one way everywhere,” says McIntyre, Assistant Professor (Status) at the Leslie Dan Faculty of Pharmacy. “We might have similar challenges with antimicrobial stewardship, but the systems in place at Sinai Health or University Health Network might not necessarily work in Timmins. The interventions need to be tailored depending on the culture and systems in the hospital.”

The Timmins team identified key questions around how to raise awareness and measure statistics related to antimicrobial stewardship, as well as potential interventions. The students then worked in groups to research and develop recommendations for the hospital and presented their work to Solomon and members of the hospital’s pharmacy, infection control and IT departments, as well as senior management.

“The experience was gratifying, but also a bit scary because you're presenting your ideas to actual hospital executives and you don't know whether they're going to agree with you. Our approach was to work together and present our best work,” Elia says. “I learned how to approach your communication based on who you're speaking to. For example, for the hospital executives, we researched the hospital’s values and then leveraged that to show the executives how the program could match their values.”

Solomon says she was impressed with the students’ innovative ideas that considered the hospital’s goals and long-term vision, and involving the hospital’s management in the project helped raise awareness that will be essential to the success of any antimicrobial stewardship programs the hospital undertakes.

“The challenges that we face in Timmins are similar to the challenges that other facilities face, and I’m glad the students were able to give us a head start on looking into these issues and looking for potential solutions,” she says. “Being part of this project got the ball rolling so much faster than if I had worked on it alone. And involving the hospital’s management put antimicrobial stewardship on their radar as something that should be part of the hospital’s goals.”

Project will run again in a different setting

McIntyre enjoyed giving students a small taste of what they can expect when they encounter antimicrobial stewardship in their future pharmacy practices.

“My goal was to have the students practically apply the concepts they learn in the course to a real-world situation to make actual change. This project captured students’ imaginations, and they grew from not fully understanding the topic to putting it into practice,” he says. “As health clinicians, we also saw that learners can contribute to health care capacity and help fill gaps where they are needed. While they are still in school, their research and ideas can have an impact in the health care system.”

The project was such a success that McIntyre is hoping to do a similar project this fall working with a hospital in Barbados. After all, says McIntyre, despite the many differences between working in Toronto, Timmins and Barbados, the core challenge of antimicrobial resistance is the same.

“Whether you’re in a geographically remote setting, an island, or a big city, we’re not that dissimilar from each other, so what lessons can we learn from each other to tackle this issue?” he says. “Learning from these unique settings is also helpful as we try to craft our own strategies within our own hospitals to improve care. The specifics of the problem may be different, but the overall challenge is the same.”