Info for health service organisations - Antimicrobial Stewardship Clinical Care Standard

What the standard says

A patient with a life-threatening condition due to a suspected infection receives an appropriate antimicrobial immediately, without waiting for the results of investigations.

What the quality statement means for health service organisations

Ensure that relevant clinical pathways and an appropriate local antimicrobial formulary are available so that clinicians can give optimal antimicrobial treatment promptly and within recommended time frames to patients with life-threatening infections.

What the standard says

When a patient is prescribed an antimicrobial, this is done in accordance with the current Therapeutic Guidelines or evidence-based, locally endorsed guidelines and the antimicrobial formulary.

What the quality statement means for health service organisations

Ensure clinicians have access to and use the current Therapeutic Guidelines and evidence-based, locally endorsed guidelines when prescribing antimicrobials. Ensure clinicians have access to and use the local antimicrobial formulary, as required, and that it is evidence based. Monitor adherence with the antimicrobial formulary, including broad-spectrum antimicrobials.

What the standard says

When an adverse reaction (including an allergy) to an antimicrobial is reported by a patient or recorded in their healthcare record, the active ingredient(s), date, nature and severity of the reaction are assessed and documented. This enables the most appropriate antimicrobial to be used when required.

What the quality statement means for health service organisations

Ensure processes are in place to support clinicians to document adverse reactions to medicines that are reported or experienced by a patient, in the patient’s healthcare record. Ensure processes are in place for clinicians to review and update information about patients’ adverse reactions to medicines in their healthcare records at each encounter, including the My Health Record system. Ensure guidelines are available for clinicians to assess adverse reactions to antimicrobials and to use the most appropriate antimicrobial when required. Ensure relevant information about adverse reactions to medicines is available for clinicians to provide to patients. Ensure processes are in place to review adverse reactions to antimicrobials in the organisation-wide incident reporting system and report them to the Therapeutic Goods Administration.

What the standard says

A patient with a suspected infection has appropriate samples taken for microbiology testing as clinically indicated, preferably before starting antimicrobial therapy.

What the quality statement means for health service organisations

Ensure clinicians have access to and use the current Therapeutic Guidelines and evidence based, locally endorsed guidelines for clinically appropriate microbiological testing. Ensure systems are in place for clinicians to take samples for microbiological testing before starting antimicrobial therapy, when clinically indicated, and for the results to be available to clinicians in a timely manner.

What the standard says

A patient with an infection, or at risk of an infection, is provided with information about their condition and treatment options in a way that they can understand. If antimicrobials are prescribed, information on how to use them, when to stop, potential side effects and a review plan is discussed with the patient.

What the quality statement means for health service organisations

Ensure systems are in place for clinicians to provide patients and/or their carers with information and advice on antimicrobial treatment options.

Ensure systems are in place so that clinicians discuss with patients and/or their carers the need to take antimicrobials as prescribed, how long to take them, any potential side effects and whether their treatment requires review.

Provide high-quality written patient materials and resources for use by clinicians and patients.

Monitor patient understanding of information provided for antimicrobial therapy and evidence of shared decision making, for example, qualitative patient surveys, patient reported experience measures, patient-reported outcome measures and/or by measuring uptake of shared decision making tools. See Appendix C in the clinical care standard publication for more information.

Ensure processes are in place to ensure information is communicated to the patient at transitions of care (such as on referral in a community setting, or on admission to or discharge from hospital) about their treatment options and antimicrobial plan.

What the standard says

When a patient is prescribed an antimicrobial, the indication, active ingredient, dose, frequency and route of administration, and the intended duration or review plan are documented in the patient’s healthcare record.

What the quality statement means for health service organisations

Ensure a system is in place so that when clinicians prescribe antimicrobials, they document the clinical reason, active ingredient, dose, frequency and route of administration, intended duration and a treatment review plan in the patient’s healthcare record. Where electronic healthcare records are being used, incorporate flags and reminders into the record management system to support documentation in all relevant fields or consider making them mandatory fields.

What the standard says

A patient prescribed an antimicrobial has regular clinical review of their therapy, with the frequency of review dependent on patient acuity and risk factors. The need for ongoing antimicrobial use, appropriate microbial spectrum of activity, dose, frequency and route of administration are assessed and adjusted accordingly. Investigation results are reviewed promptly when they are reported.

What the quality statement means for health service organisations

Ensure systems are in place for clinicians to regularly review patients who are prescribed antimicrobials, as appropriate to the clinical condition and healthcare setting. In hospital, this includes ceasing antimicrobials when no longer necessary, and reviewing within 48 hours from the first prescription. In the community, this includes communicating with the consumer about signs and symptoms for re-presentation to the clinician or a hospital.

Ensure systems are in place for clinicians to review microbiology test results as soon as they are available and use the information to guide antimicrobial treatment decisions. Where electronic healthcare records are in place, consider incorporating flags and reminders into the record management system.

Ensure processes are in place to support clinicians changing from broad-spectrum antimicrobials to appropriate narrow-spectrum agents once the pathogen and its susceptibilities are known, or after review of the patient’s clinical condition and diagnosis. Consider having processes in place to flag potential intravenous to oral switch for antimicrobials

What the standard says

A patient having surgery or a procedure is prescribed antimicrobial prophylaxis in accordance with the current Therapeutic Guidelines or evidence-based, locally endorsed guidelines. This includes recommendations about the need for prophylaxis, choice of antimicrobial, dose, route and timing of administration, and duration

What the quality statement means for health service organisations

Ensure systems are in place for clinicians to provide appropriate antimicrobial therapy to patients undergoing surgery or a procedure. Ensure these systems are based on the current Therapeutic Guidelines or evidence-based, locally endorsed guidelines.

Ensure systems and processes are in place to allow for the clear documentation of peri-procedural antimicrobial active ingredient, dose, administration time and incision time.

Assess adherence to guidelines regularly as part of a quality improvement approach. Ensure systems are in place to meet the health service organisation’s requirements for surgical antimicrobial prophylaxis in the Antimicrobial Stewardship Advisory, as part of the National Safety and Quality Health Service Preventing and Controlling Healthcare-Associated Infection Standard.

2a The proportion of antimicrobial prescriptions that are in accordance with the current Therapeutic Guidelines or evidence-based, locally endorsed guidelines.

2b The proportion of prescriptions for restricted antimicrobials that are in accordance with the locally endorsed approval policy.

3a The proportion of patients with an adverse reaction to an antimicrobial with comprehensive documentation of the reaction in their healthcare record.

6a The proportion of prescriptions for which the indication for prescribing the antimicrobial is documented.

6b The proportion of prescriptions for which the duration, stop date or review date for the antimicrobial is documented.

7a The proportion of prescriptions for which an antimicrobial review and updated treatment decision is documented within 48 hours from the first prescription.

8a The proportion of patients for whom the perioperative prophylactic antimicrobial is prescribed in accordance with the current Therapeutic Guidelines or evidence-based, locally endorsed guidelines.

8b The proportion of patients for whom the perioperative prophylactic antimicrobial dose is prescribed in accordance with the current Therapeutic Guidelines or evidence-based, locally endorsed guidelines.

8c The proportion of patients who are administered prophylactic antimicrobials within the recommended time perioperatively.

8d The proportion of patients were prescribed prolonged antimicrobials following a surgery or procedure that is discordant with the current Therapeutic Guidelines or evidence-based, locally endorsed guidelines.