To learn more about infectious disease pharmacists and the multi-faceted role Antimicrobial Stewardship teams play in hospitals, we spoke with Maria Coccimiglio, one of only 16 Board-Certified Infectious Disease Pharmacists in Canada and Pharmacy Professional Practice Leader at Sault Area Hospital.

Maria has been a pharmacist for 25 years, predominantly working in the Sault Area Hospital as a staff and clinical pharmacist. Though she graduated from Ferris State University College of Pharmacy and worked in Michigan, much of her career has been in community hospital.

Prior to finding her niche, Maria served as department manager on an interim basis, pharmacy lead for implementation of a new electronic health system and teacher at a local community college. Ultimately, Maria’s love for clinical pharmacy and patient interaction drew her back to clinical work.

Q: Can you tell us a little about what antimicrobial stewardship is?

A: Generally, antimicrobial stewardship promotes the judicious use of antimicrobials to limit the development of resistant organisms.

An Antimicrobial Stewardship program is an interdisciplinary coordinated program that promotes the appropriate use of antimicrobials, improves patient outcomes, reduces microbial resistance, and decreases the spread of infections.

On a day-to-day basis we review the need for antimicrobials, the appropriate selection, dosing, route, and duration of therapy. We also provide education for staff and patients and develop guidance documents on best practice for infectious disease syndromes.

Q: What sparked your interest in antimicrobial stewardship?

A: Initially, I started out doing Drug Use evaluations on select antibiotics to try and understand how we were using them. Through my role as a professional practice leader, I became involved with our Pharmacy and Therapeutics committee and was able to help develop and influence policies and procedures around our use of antibiotics.

In 2014, I attended a MAD-ID (Making a Difference in Infectious Disease) Conference on Antimicrobial Stewardship and realized I had found my niche. It helped me recognize how many opportunities we had to improve and make a difference, not just at my hospital but globally.

That same year I was asked to help develop our antimicrobial stewardship program to meet the Required Organizational Practice (ROP) issued by Accreditation Canada for Canadian hospitals. I jumped at this, and the rest is history! I was able to complete an ASP advanced training program through MAD-ID in 2017.

For me, ASP enhances quality care and improves patient safety globally. We must work together if we want to overcome worldwide, antimicrobial resistance—which has emerged as a serious public health threat. Preserving the ability to use antimicrobials effectively for the future is something I am passionate about.

Q: You’re one of only 16 BPS Board Certified Infectious Diseases Pharmacists in Canada. What is the process to obtain that certification?

A: BPS Board certification in a pharmacy specialty recognizes an individual who has gained additional knowledge, experience, and skills in a defined area of pharmacy practice. The BPS Board Certified Infectious Diseases Pharmacist (BCIDP) program is a credential for pharmacists who specialize in the use of microbiology and pharmacology to develop, implement, and monitor drug regimens to optimize therapy for patients.

To be eligible, pharmacists must have 4 years’ experience in infectious disease or antimicrobial stewardship or have completed a specialized pharmacy residency in infectious diseases.

Q: How do you use your knowledge in your role?

A: I use my knowledge of infectious disease every day. My goal as an antimicrobial steward is to ensure antibiotics are used properly by reviewing that the right antibiotics are used at the right time, right dose, and for the proper duration. My knowledge gives me the confidence to be able to assess patient’s therapy and have conversations with the team on best practice and evidence-based strategies.

For me, the main reason for seeking board certification was about proving to myself I could do this and improving my own feelings of self-worth and competence. I have been fortunate enough to work with some amazing pharmacist advocates and leaders throughout my career that have inspired me along the way.

Q: Can you take us through what a typical workday looks like?

A: A typical workday is never typical! One thing I do every day is review and follow-up on patients with bloodstream infections to make sure we are treating their illness properly. I also review patients using antibiotics with a broad spectrum to see if we can tailor them down to an antibiotic with just the coverage they need. I also monitor and maximize antibiotic dosing for certain organisms, working closely with our microbiology department.

Right now, we are dealing with caring for COVID patients, so I am part of the team ensuring COVID treatments are maximized for them. Sometimes, I also help monitor ambulatory outpatients under the care of our infectious disease physician. We are often asked to help with dosing, side effect monitoring and treatment recommendations, etc.

Q: How has your role changed over the course of the pandemic?

A: Staying on top of the rapidly changing scientific information with COVID has been key throughout the pandemic. In the early stages, it was a lot of planning for how we would care for patients. As the pandemic evolved, I worked as part of the team to implement treatment algorithms and ensure drug procurement. We worked to be able to offer drug treatments as they became available to our high risk COVID patients in the community to reduce their chances of progressing to more serious disease.  Monitoring patients in treatment is also a big part of my day now.

Q: What is most exciting to you about the pharmacy profession at this time?

A: I think what’s most exciting about the pharmacy profession is how dynamic it is. The last two years have really pushed what we can do for patients and the healthcare system to the forefront. We truly are the medication experts. Although the pandemic has put some serious pressure on the pharmacy profession, it also allowed us to show how resilient and agile our profession is (pharmacists and technicians alike) and to use our full professional potential and skill set.

Q: Is there a piece of advice you’d offer to someone looking to become a pharmacist?

A: My advice to someone looking to become a pharmacist is to commit to excellence. What I mean by this is once you graduate, commit early on to making excellence a part of your practice. Stay on top of the best practices, gain new skills, inspire those around you to do the same and this will improve patient outcomes, improve your overall experience, and job satisfaction. Find your niche.

My other piece of advice is to surround yourself with mentors – join professional and or specialty pharmacy groups and organizations and participate in them. Allow yourself to be mentored and mentor others. It will change your entire career.