25 November 2022
If there is anyone who can convince you that microbes are fascinating its Hamish Patterson.
As the Antimicrobial Stewardship Pharmacist at Wagga Wagga Base Hospital, Hamish loves nothing better than figuring out the right drug for your bug.
On finishing school in Cootamundra, Hamish wasn’t sure what he wanted to do, so he sought inspiration from his favourite subjects at school and headed to Canberra to study a general Bachelor of Applied Science, leaving his options open.
It was while living in a share house with a Pharmacy student that he found his direction.
“We’d spend hours discussing his assignments – I was hooked,” said Hamish.
“I realised I’d always been interested in something as simple as having a headache – you take ibuprofen and it goes away – but if you didn’t you’d still have a headache and your day would be ruined.
“I’d think ‘how does that work? How does it happen? That’s really cool!’
“By extension now I’m like that with every drug – how will it work? Why does it work for you and not for someone else?”
After completing his Pharmacy degree and internship, Hamish returned to the Murrumbidgee in 2017 for a management opportunity as the Deputy Director of Pharmacy with MLHD. He took on the role of Antimicrobial Stewardship Pharmacist at Wagga Base Hospital three years ago.
“Infections and the different antimicrobials we can use to target these fascinate me,” said Hamish. “The opportunity to specialise in that as a Pharmacist and to be involved in that aspect of a patient’s care is really rewarding.
“We can guide therapy in terms of optimising doses and use dose calculation software to do therapeutic drug monitoring, to make sure we are getting effective use but preventing toxicity and side effects.”
The field of antimicrobials and antimicrobial resistance is an emerging field. Ensuring accurate records and validated data enables Hamish to contribute by sharing that data and looking for opportunities to learn more.
“We present our data at a meeting of our peers where we look at our utilisation of antimicrobials, and if there are any trends and anomalies we can look into it further – for example is there an emerging resistant antimicrobial? Are we inadvertently creating resistance by using a certain type of treatment? Or are we perhaps jumping to the big guns first without considering some of the other options?”
Hamish cannot speak more highly of Dr Timothy Gilbey, MLHD’s Infectious Disease Specialist.
“Dr Gilbey is such a wealth of knowledge, and so generous with his time,” said Hamish. “If you have a question, and you’re genuinely curious, he will spend the time to teach you and I really appreciate that.”
“If I notice anything in our data that stands out I liaise with Dr Gilbey and we look into it a bit further - for example if we’ve used a lot of a specific antimicrobial in certain period we can tease it down further in case there’s perhaps some resistant organisms that we need to monitor closely.”
“There’s a big focus on the data and ensuring you have reliable data – you have to have the confidence to challenge other members of the treating team so you need that validated data to back it up.
“At the end of the day what we’re trying to find out is ‘are we following best practice?’ Because the consequence if we aren’t is that we end up with more resistant bugs. Then we have to use broader spectrum antimicrobials which may be associated with more side effects and therefore increase length of hospital stay for a patient.”
Antibiotic allergies are something that also interests Hamish, particularly penicillin allergies.
“About 10% of the population will have a penicillin allergy on their medical record, but up to 90% of those patients may not in fact have a true allergy. For example they may have self-reported it based on symptoms that may attributable to the illness rather than the medication, or it may have been some time ago and changes to the way penicillin is manufactured may mean it is no longer current. We’re also discovering people don’t necessarily hold on to a penicillin allergy forever.
“For our patients in hospital there are real benefits to challenging a reported penicillin allergy (under close medical supervision of course). If we find you could safely receive penicillin it then opens up a whole family of antibiotics that we can use to help get you well as quickly and safely as possible. Penicillins are used and preferred for a range of infections. So that is something I am really looking forward to investigating further and seeing the benefits for our patients.”
With his respect for data, and curious nature it is not surprising that Hamish would love to do more research in the future.
“We were part of the ASCOT clinical trial at Wagga Base, which was trialling an anti-viral therapy to see if it was effective at reducing severe illness in people with COVID-19.
“I’d love to be involved in more research in the future. It is really rewarding to know that you’re contributing to something that will improve care for patients and potentially reduce the amount of time they spend in hospital.”
Hamish was also keen to point out that he is just one part of a greater team.
“It’s a really great team to be a part of, Dr Gilbey, my colleagues in pharmacy, the doctors, nurses, pathologists and microbiologists. We’re all here to do our part to work out what is happening, and how we can make you well again.”