Review of therapy

Quality statement 7 - Antimicrobial Stewardship Clinical Care Standard

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.

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Purpose

To optimise patients’ antimicrobial therapy through clinical assessment and review of the appropriateness of the antimicrobial and of investigation results.

To prevent unnecessary antimicrobial use, including of the use of broad-spectrum antimicrobials where a narrow-spectrum antimicrobial could be used, to reduce the potential to drive antimicrobial resistance.

To ensure the appropriate dosing regimen and route of antimicrobials to adequately treat or prevent an infection, improve patient outcomes and reduce patient harm (for example, when a patient has renal impairment, or when oral options can replace intravenous use). This may include therapeutic drug monitoring.

For patients

If you are prescribed a medicine for an infection, your clinician should regularly check that you still need the medicine and that it’s the best medicine for you. If tests have been done to find out what kind of infection you have, your clinician should review these results as soon as they are available. When your infection has improved, it may be appropriate to stop or change how you use this medicine (for example, changing from an injection, infusion or drip to a medicine you take by mouth).

If the cause of your infection is unclear, you may be prescribed a medicine that works against different types of infections. You may need to have tests (such as a blood or urine test) to check if the medicine is working. Depending on the test results, your treatment may need to continue, change or stop.

For clinicians

If antimicrobials are prescribed, review the patient’s progress to assess whether ongoing treatment is needed. If the patient is on intravenous agents, consider oral options to reduce hospital-acquired infections. Ensure the antimicrobial agent and dose are appropriate for the site of the infection and patient parameters (such as renal function).

If microbiological tests are ordered, review the results within 24 hours of them being available, and use this information to consider whether changing or stopping antimicrobials is appropriate.

When prescribing a broad-spectrum antimicrobial, review the patient’s clinical status and any microbiology results to determine whether the patient’s treatment can be switched to a more narrow-spectrum agent to reduce potential patient harms and the risk of developing antimicrobial resistance.

For health service organisations

Ensure systems are in place so clinicians 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 so clinicians 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 where possible.

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 parenteral to oral switch for antimicrobials.

For patients

If you are prescribed a medicine for an infection, your clinician should regularly check that you still need the medicine and that it’s the best medicine for you. If tests have been done to find out what kind of infection you have, your clinician should review these results as soon as they are available. When your infection has improved, it may be appropriate to stop or change how you use this medicine (for example, changing from an injection, infusion or drip to a medicine you take by mouth).

If the cause of your infection is unclear, you may be prescribed a medicine that works against different types of infections. You may need to have tests (such as a blood or urine test) to check if the medicine is working. Depending on the test results, your treatment may need to continue, change or stop.

For clinicians

If antimicrobials are prescribed, review the patient’s progress to assess whether ongoing treatment is needed. If the patient is on intravenous agents, consider oral options to reduce hospital-acquired infections. Ensure the antimicrobial agent and dose are appropriate for the site of the infection and patient parameters (such as renal function).

If microbiological tests are ordered, review the results within 24 hours of them being available, and use this information to consider whether changing or stopping antimicrobials is appropriate.

When prescribing a broad-spectrum antimicrobial, review the patient’s clinical status and any microbiology results to determine whether the patient’s treatment can be switched to a more narrow-spectrum agent to reduce potential patient harms and the risk of developing antimicrobial resistance.

For health service organisations

Ensure systems are in place so clinicians 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 so clinicians 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 where possible.

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 parenteral to oral switch for antimicrobials.

Quality statement 7 has an indicator for local monitoring.

Read Quality statement 8 - Surgical and procedural prophylaxis

Related links
Clinical Care Standards
Antimicrobial Stewardship Clinical Care Standard
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