This action states

The antimicrobial stewardship program will:

  1. Review antimicrobial prescribing and use
  2. Use surveillance data on antimicrobial resistance and use to support appropriate prescribing
  3. Evaluate performance of the program, identify areas for improvement, and take action to improve the appropriateness of antimicrobial prescribing and use
  4. Report to clinicians and the governing body regarding
    • compliance with the antimicrobial stewardship policy
    • antimicrobial use and resistance
    • appropriateness of prescribing and compliance with current evidence-based Australian therapeutic guidelines or resources on antimicrobial prescribing

Intent

The antimicrobial stewardship (AMS) program promotes safe and appropriate antimicrobial prescribing and use through ongoing monitoring, evaluation and improvement activities.

Reflective questions

What processes are in place to evaluate antimicrobial use?

How does the health service organisation use surveillance data on local antimicrobial resistance and use to support appropriate prescribing?

What actions have been taken to improve the effectiveness of the AMS processes?

How are data on prescribing and use of antimicrobials reported to clinicians and the governing body?

Key tasks

  • Collect and regularly review data on antimicrobial use (volume and appropriateness) and local resistance to identify areas for improvement and ascertain the effectiveness of AMS interventions
  • Monitor quality indicators to assess prescribing practice and AMS program effectiveness
  • Use the results of monitoring activities to decide on priorities and actions for improvement
  • Set up a system that ensures that feedback is provided to prescribers on results of monitoring and assessment activity.
  • Report routinely to the organisational governing body and the chief executive on AMS processes and outcomes.

Strategies for improvement

Hospitals

Monitoring and analysing antimicrobial use are critical to understanding patterns of prescribing, the impact on patient safety and antimicrobial resistance, as well as to measure the effectiveness of, and identify means to improve, the AMS program. Antimicrobial use can be measured in terms of quantity, quality (that is, appropriateness of prescribing according to guidelines) or expenditure.

Decide on areas for monitoring and improvement

Map current data collection systems across all departments to identify those that can be used to support monitoring and evaluation of AMS (note that a lot of data are routinely collected throughout health service organisations and it is important to identify what is already available to avoid duplication of effort). Examples include:

  • Pharmacy data collection systems – for information about trends in antimicrobial use
  • Data collected as part of performance monitoring for sepsis
  • Emergency department indicators reviewing time to first dose of antibiotics
  • Healthcare record systems
  • Electronic medication management systems
  • Pathology department audits
  • Data on the incidence of surgical site infections.

Use the risk assessment principles outlined in Action 3.1 to decide on priority areas for monitoring and improvement. Ensure that antimicrobial use monitoring includes intensive care units and oncology units, as the control of resistance in these areas can affect other areas of a health service organisation. Other priorities for monitoring may include conditions commonly associated with high antimicrobial use (for example, sepsis, urinary tract infections, respiratory tract infections, surgical prophylaxis) or high-risk antimicrobials (for example, third-generation cephalosporins, carbapenems).

Take part in state or territory, or national programs to monitor antimicrobial use and appropriateness that provide readily accessible audit and monitoring tools. Examples are:

Work with clinical microbiology services to ensure reporting of selective susceptibilities, and review antimicrobial use data in association with resistance data to identify any patterns.

Act to improve prescribing

Support the AMS team to provide an AMS service that:

  • Uses data from audits of prescribing and antimicrobial use to give feedback to clinicians on prescribing appropriateness, as part of AMS team or pharmacy review
  • Publishes reports on antimicrobial use and appropriateness; this could be whole-of-organisation data or broken down into individual ward or division information.

To engage individual clinicians and focus efforts, present data and feedback focused on specific clinical conditions and appropriateness of therapy.

To inform local empirical therapy recommendations and formulary management, make antimicrobial susceptibility tables (antibiograms) available to clinicians and groups responsible for local antimicrobial therapy guidelines. Because antibiograms can be difficult to interpret, ensure appropriate expertise from clinical microbiologists or infectious diseases specialists to help analyse the antibiogram and plan appropriate actions. If antibiograms are used, they should be consistent with the national specifications for a hospital-level cumulative antibiogram.

Provide resources and tools at the point of care to promote appropriate antimicrobial prescribing, such as:

  • Posters targeting both prescribers and patients
  • Laminated cards that can be placed in medication rooms or be developed as pocket cards as a quick reference
  • Stickers or electronic prompts that can be used as reminders to review patients and treatment.

Implement or review clinical pathways for specific infections or conditions. Ensure that clinical pathways include steps to allow appropriate investigations, routine review of therapy, de-escalation, intravenous-to-oral switch and limiting the duration of therapy.

Establish clinical pathways for common, high-volume and high-risk conditions; examples might include Staphylococcus aureus bacteraemia, bone and joint infections, community-acquired pneumonia, surgical prophylaxis, sepsis and antimicrobial-related allergy.

Use state or territory, or national guidelines or resources to implement a formal intravenous-to-oral switch program.

Require all new prescribers to complete the NPS MedicineWise antimicrobial modules.

Communicate about safe and appropriate use of antimicrobials:

  • Provide regular updates about the AMS program to members of the clinical workforce using different methods, such as newsletters, screensavers, meetings and posters
  • Take part in annual Antibiotic Awareness Week activities
  • Ensure that patients and carers receive current Australian education materials on safe and appropriate use of antimicrobials.

Set up systems for communication with other clinicians about antimicrobial management. This is especially important for transitions of care, and includes internal communication, and external communication with general practitioners, members of the aged care workforce and other prescribers.

Monitor and evaluate the AMS program

Use the quality improvement framework outlined in Action 3.2 to evaluate the program, and identify opportunities and actions for improvement.

Use process and outcome measures to monitor and evaluate the program. Possible process measures include:

Possible outcome measures include:

  • S. aureus bacteraemia–related mortality
  • Infection-related length of stay (for example, central line-related sepsis, ventilator-related complications, multidrug-resistant organism infections)
  • Infection-related readmissions (for example, joint replacement surgery)
  • Reduced antimicrobial expenditure.

Contribute data on antimicrobial use and appropriateness to relevant state or territory, or national programs (for example, NAPS and NAUSP) to enable benchmarking as part of program evaluation.

Report on AMS program processes and outcomes

Responsibility for monitoring the effectiveness of the AMS program and ensuring accountability for actions lies with the governing body of the organisation. The governing body also has a role in allocating resources to achieve program goals and outcomes.

Provide a report every year to the chief executive and governance units that summarises:

  • Current AMS resources
  • AMS team activity
  • Performance against process and outcome indicators for antimicrobial use, appropriateness and resistance
  • Key areas of improvement
  • Areas for further improvement or priority
  • Areas in which guidance or support from chief executive and governance units is needed.

Refer to the Options for Implementing Antimicrobial Stewardship in Different Facilities resource for examples of monitoring and reporting activities in different settings.

Day Procedure Services

Monitoring and analysing antimicrobial use are critical to understanding patterns of prescribing, the impact on patient safety and antimicrobial resistance, as well as to measure the effectiveness of, and identify means to improve, the AMS program. Antimicrobial use can be measured in terms of quantity, quality (that is, appropriateness of prescribing according to guidelines) or expenditure.

Decide on areas for monitoring and improvement

Map current data collection systems to identify those that can be used to support monitoring and evaluation of AMS. Examples include:

  • Pharmacy data collection systems – for information about trends in antimicrobial use
  • Data on volume of use of antimicrobials
  • Evaluation of medicines use
  • Healthcare record systems
  • Electronic medication management systems
  • Pathology department audits
  • Purchasing data for antimicrobials.

If possible, use data that are routinely collected to avoid duplication of effort.

Use the risk assessment principles outlined in Action 3.1 to decide on priority areas for monitoring and improvement. Monitor antimicrobial use appropriate to the scope of services and procedures undertaken in the day procedure service. Priorities will include procedures associated with high levels of antimicrobial use or high-risk antimicrobials (for example, third-generation cephalosporins, carbapenems).

Conduct local audits and reviews as part of the AMS program plan, or participate in reviews and monitoring processes regarding antimicrobial use and resistance conducted by the Local Hospital Network, private hospital group, or state or territory.

Take part in state or territory, or national programs to monitor antimicrobial use and appropriateness that provide readily accessible audit and monitoring tools. Examples are:

Work with clinical microbiology or pathology services to ensure reporting of selective susceptibilities, and review antimicrobial use data in association with resistance data to identify any patterns.

Act to improve prescribing

Support the AMS team to provide an AMS service that:

  • Uses data from audits of prescribing and antimicrobial use to give feedback to clinicians on prescribing appropriateness, as part of AMS team or pharmacy review
  • Publishes reports on antimicrobial use and appropriateness.

To inform local empirical therapy recommendations and formulary management, make antimicrobial susceptibility tables (antibiograms) available to clinicians and groups responsible for local antimicrobial therapy guidelines. Because antibiograms can be difficult to interpret, ensure appropriate expertise from clinical microbiologists or infectious diseases specialists to help analyse the antibiogram and plan appropriate actions. If antibiograms are used, they should be consistent with the national specifications for hospital-level cumulative antibiogram.

Provide resources and tools at the point of care to promote appropriate antimicrobial prescribing, such as:

  • Posters targeting both prescribers and patients
  • Laminated cards or pocket cards.

Implement or review clinical pathways for specific procedures and conditions.

Require all new prescribers to complete the NPS MedicineWise antimicrobial modules.

Communicate about safe and appropriate use of antimicrobials:

  • Provide regular updates about the AMS program to members of the clinical workforce using different methods, such as newsletters, screensavers, meetings and posters
  • Take part in annual Antibiotic Awareness Week activities
  • Ensure that patients and carers receive current Australian education materials on safe and appropriate use of antimicrobials.

Set up systems for communication about patient care and antimicrobial management with other treating clinicians and caregivers. This is particularly important for transitions of care, and includes internal communication, and external communication with general practitioners, members of the aged care workforce and other prescribers.

Monitor and evaluate the AMS program

Use the quality improvement framework outlined in Action 3.2 to evaluate the AMS program, and identify opportunities and actions for improvement.

Use process and outcome measures to monitor and evaluate the program. Possible process measures include:

Possible outcome measures include:

  • S. aureus bacteraemia–related mortality
  • Infection-related readmissions (for example, joint replacement surgery)
  • Reduced antimicrobial expenditure.

Contribute data on antimicrobial use and appropriateness to relevant programs to enable benchmarking as part of program evaluation. Depending on the type of service, relevant programs could include:

  • Programs undertaken between like services across provider groups
  • State or territory programs
  • National programs such as the Surgical NAPS or NAUSP.

Report on AMS program processes and outcomes

Responsibility for monitoring the effectiveness of the AMS program and ensuring accountability for actions lies with the governing body of the organisation. The governing body also has a role in allocating resources to achieve program goals and outcomes.

Provide a report every year to the chief executive and governance units that summarises:

  • Current AMS resources
  • AMS team activity
  • Performance against process and outcome indicators for antimicrobial use, appropriateness and resistance
  • Key areas of improvement
  • Areas for further improvement or priority
  • Areas in which guidance or support from the chief executive and the governing body is needed.

Refer to Antimicrobial Stewardship in Australian Hospitals and hospitals tab for more detailed implementation strategies for this action.

Examples of evidence

Select only examples currently in use:

  • Committee and meeting records in which compliance with the AMS policy, and antimicrobial prescribing and use were discussed, including reviews of surveillance data
  • Results of analysis of surveillance data on antimicrobial resistance and use
  • Results of NAPS or other audits and surveys about appropriateness of prescribing
  • Improvement activities for AMS that have been implemented and evaluated
  • Communications with clinicians on antimicrobial use, resistance and stewardship in the health service organisation.

MPS & Small Hospitals

Monitoring and analysis of antimicrobial use are critical to understanding patterns of prescribing, the impact on patient safety and antimicrobial resistance, as well as to measure the effectiveness of, and identify means to improve, the AMS program. Antimicrobial use can be measured in terms of quantity, quality (that is, appropriateness of prescribing according to guidelines) or expenditure.

MPSs or small hospitals that are part of a local health network or private hospital group should adopt or adapt and use the established process for monitoring, evaluating and reporting on the organisation’s antimicrobial stewardship program.

Small hospitals that are not part of a local health network or private hospital group should:

  • Collect and regularly review data on antimicrobial use (volume and appropriateness) and local resistance to identify areas for improvement and ascertain the effectiveness of AMS interventions
  • Monitor quality indicators to assess prescribing practice and AMS program effectiveness
  • Use the results of monitoring activities to decide on priorities and actions for improvement
  • Set up a system that ensures that feedback is provided to prescribers on results of monitoring and assessment activity
  • Report routinely to the organisational governing body and the chief executive on AMS processes and outcomes.

Take part in state or territory, or national programs to monitor antimicrobial use and appropriateness that provide readily accessible audit and monitoring tools. Examples are:

Support the AMS team to:

  • Use data on prescribing and antimicrobial use to give feedback to clinicians and clinical teams on prescribing appropriateness, as part of AMS team or pharmacy rounds
  • Publish reports on antimicrobial use and appropriateness.

Implement or review clinical pathways for specific infections or conditions. Ensure that clinical pathways include steps to allow appropriate investigations, routine review of therapy, de-escalation, intravenous-to-oral switch and limiting the duration of therapy.

Set up clinical pathways for common, high-volume and high-risk conditions; examples might include Staphylococcus aureus bacteraemia, bone and joint infections, community-acquired pneumonia, surgical prophylaxis, sepsis and antimicrobial-related allergy.

Use state or territory, or national guidelines or resources to implement a formal intravenous-to-oral switch program.

Require all new prescribers to complete the NPS MedicineWise antimicrobial modules.

Communicate about safe and appropriate use of antimicrobials:

  • Provide regular updates about the AMS program to members of the clinical workforce using different methods, such as newsletters, screensavers, meetings and posters
  • Take part in annual Antibiotic Awareness Week activities
  • Ensure that patients and carers receive current Australian education materials on safe and appropriate use of antimicrobials.

Monitor and evaluate the AMS program using process and outcome measures such as:

  • Antimicrobial Stewardship Clinical Care Standard indicators
  • Indicators to support Antimicrobial Stewardship (AMS) programs
  • Infection- or antimicrobial-related incidents (for example, sentinel events such as S. aureus bacteraemia, or adverse events relating to antimicrobial administration or dosing)
  • S. aureus bacteraemia–related mortality
  • Infection-related length of stay (for example, central line-related sepsis, ventilator-related complications, multidrug-resistant organism infections)
  • Infection-related readmissions (for example, joint replacement surgery)
  • Reduced antimicrobial expenditure.

Report on AMS program processes and outcomes

Report at least annually to the chief executive and relevant governance committees on:

  • AMS resources
  • AMS team activity
  • Performance against process and outcome indicators for antimicrobial use, appropriateness and resistance
  • Key areas of improvement
  • Areas for further improvement or priority
  • Areas in which guidance or support from the chief executive and governing committees is needed.

Refer to the Options for Implementing Antimicrobial Stewardship in Different Facilities resource for examples of monitoring and reporting activities in different settings.

Hospitals

Monitoring and analysing antimicrobial use are critical to understanding patterns of prescribing, the impact on patient safety and antimicrobial resistance, as well as to measure the effectiveness of, and identify means to improve, the AMS program. Antimicrobial use can be measured in terms of quantity, quality (that is, appropriateness of prescribing according to guidelines) or expenditure.

Decide on areas for monitoring and improvement

Map current data collection systems across all departments to identify those that can be used to support monitoring and evaluation of AMS (note that a lot of data are routinely collected throughout health service organisations and it is important to identify what is already available to avoid duplication of effort). Examples include:

  • Pharmacy data collection systems – for information about trends in antimicrobial use
  • Data collected as part of performance monitoring for sepsis
  • Emergency department indicators reviewing time to first dose of antibiotics
  • Healthcare record systems
  • Electronic medication management systems
  • Pathology department audits
  • Data on the incidence of surgical site infections.

Use the risk assessment principles outlined in Action 3.1 to decide on priority areas for monitoring and improvement. Ensure that antimicrobial use monitoring includes intensive care units and oncology units, as the control of resistance in these areas can affect other areas of a health service organisation. Other priorities for monitoring may include conditions commonly associated with high antimicrobial use (for example, sepsis, urinary tract infections, respiratory tract infections, surgical prophylaxis) or high-risk antimicrobials (for example, third-generation cephalosporins, carbapenems).

Take part in state or territory, or national programs to monitor antimicrobial use and appropriateness that provide readily accessible audit and monitoring tools. Examples are:

Work with clinical microbiology services to ensure reporting of selective susceptibilities, and review antimicrobial use data in association with resistance data to identify any patterns.

Act to improve prescribing

Support the AMS team to provide an AMS service that:

  • Uses data from audits of prescribing and antimicrobial use to give feedback to clinicians on prescribing appropriateness, as part of AMS team or pharmacy review
  • Publishes reports on antimicrobial use and appropriateness; this could be whole-of-organisation data or broken down into individual ward or division information.

To engage individual clinicians and focus efforts, present data and feedback focused on specific clinical conditions and appropriateness of therapy.

To inform local empirical therapy recommendations and formulary management, make antimicrobial susceptibility tables (antibiograms) available to clinicians and groups responsible for local antimicrobial therapy guidelines. Because antibiograms can be difficult to interpret, ensure appropriate expertise from clinical microbiologists or infectious diseases specialists to help analyse the antibiogram and plan appropriate actions. If antibiograms are used, they should be consistent with the national specifications for a hospital-level cumulative antibiogram.

Provide resources and tools at the point of care to promote appropriate antimicrobial prescribing, such as:

  • Posters targeting both prescribers and patients
  • Laminated cards that can be placed in medication rooms or be developed as pocket cards as a quick reference
  • Stickers or electronic prompts that can be used as reminders to review patients and treatment.

Implement or review clinical pathways for specific infections or conditions. Ensure that clinical pathways include steps to allow appropriate investigations, routine review of therapy, de-escalation, intravenous-to-oral switch and limiting the duration of therapy.

Establish clinical pathways for common, high-volume and high-risk conditions; examples might include Staphylococcus aureus bacteraemia, bone and joint infections, community-acquired pneumonia, surgical prophylaxis, sepsis and antimicrobial-related allergy.

Use state or territory, or national guidelines or resources to implement a formal intravenous-to-oral switch program.

Require all new prescribers to complete the NPS MedicineWise antimicrobial modules.

Communicate about safe and appropriate use of antimicrobials:

  • Provide regular updates about the AMS program to members of the clinical workforce using different methods, such as newsletters, screensavers, meetings and posters
  • Take part in annual Antibiotic Awareness Week activities
  • Ensure that patients and carers receive current Australian education materials on safe and appropriate use of antimicrobials.

Set up systems for communication with other clinicians about antimicrobial management. This is especially important for transitions of care, and includes internal communication, and external communication with general practitioners, members of the aged care workforce and other prescribers.

Monitor and evaluate the AMS program

Use the quality improvement framework outlined in Action 3.2 to evaluate the program, and identify opportunities and actions for improvement.

Use process and outcome measures to monitor and evaluate the program. Possible process measures include:

Possible outcome measures include:

  • S. aureus bacteraemia–related mortality
  • Infection-related length of stay (for example, central line-related sepsis, ventilator-related complications, multidrug-resistant organism infections)
  • Infection-related readmissions (for example, joint replacement surgery)
  • Reduced antimicrobial expenditure.

Contribute data on antimicrobial use and appropriateness to relevant state or territory, or national programs (for example, NAPS and NAUSP) to enable benchmarking as part of program evaluation.

Report on AMS program processes and outcomes

Responsibility for monitoring the effectiveness of the AMS program and ensuring accountability for actions lies with the governing body of the organisation. The governing body also has a role in allocating resources to achieve program goals and outcomes.

Provide a report every year to the chief executive and governance units that summarises:

  • Current AMS resources
  • AMS team activity
  • Performance against process and outcome indicators for antimicrobial use, appropriateness and resistance
  • Key areas of improvement
  • Areas for further improvement or priority
  • Areas in which guidance or support from chief executive and governance units is needed.

Refer to the Options for Implementing Antimicrobial Stewardship in Different Facilities resource for examples of monitoring and reporting activities in different settings.

Day Procedure Services

Monitoring and analysing antimicrobial use are critical to understanding patterns of prescribing, the impact on patient safety and antimicrobial resistance, as well as to measure the effectiveness of, and identify means to improve, the AMS program. Antimicrobial use can be measured in terms of quantity, quality (that is, appropriateness of prescribing according to guidelines) or expenditure.

Decide on areas for monitoring and improvement

Map current data collection systems to identify those that can be used to support monitoring and evaluation of AMS. Examples include:

  • Pharmacy data collection systems – for information about trends in antimicrobial use
  • Data on volume of use of antimicrobials
  • Evaluation of medicines use
  • Healthcare record systems
  • Electronic medication management systems
  • Pathology department audits
  • Purchasing data for antimicrobials.

If possible, use data that are routinely collected to avoid duplication of effort.

Use the risk assessment principles outlined in Action 3.1 to decide on priority areas for monitoring and improvement. Monitor antimicrobial use appropriate to the scope of services and procedures undertaken in the day procedure service. Priorities will include procedures associated with high levels of antimicrobial use or high-risk antimicrobials (for example, third-generation cephalosporins, carbapenems).

Conduct local audits and reviews as part of the AMS program plan, or participate in reviews and monitoring processes regarding antimicrobial use and resistance conducted by the Local Hospital Network, private hospital group, or state or territory.

Take part in state or territory, or national programs to monitor antimicrobial use and appropriateness that provide readily accessible audit and monitoring tools. Examples are:

Work with clinical microbiology or pathology services to ensure reporting of selective susceptibilities, and review antimicrobial use data in association with resistance data to identify any patterns.

Act to improve prescribing

Support the AMS team to provide an AMS service that:

  • Uses data from audits of prescribing and antimicrobial use to give feedback to clinicians on prescribing appropriateness, as part of AMS team or pharmacy review
  • Publishes reports on antimicrobial use and appropriateness.

To inform local empirical therapy recommendations and formulary management, make antimicrobial susceptibility tables (antibiograms) available to clinicians and groups responsible for local antimicrobial therapy guidelines. Because antibiograms can be difficult to interpret, ensure appropriate expertise from clinical microbiologists or infectious diseases specialists to help analyse the antibiogram and plan appropriate actions. If antibiograms are used, they should be consistent with the national specifications for hospital-level cumulative antibiogram.

Provide resources and tools at the point of care to promote appropriate antimicrobial prescribing, such as:

  • Posters targeting both prescribers and patients
  • Laminated cards or pocket cards.

Implement or review clinical pathways for specific procedures and conditions.

Require all new prescribers to complete the NPS MedicineWise antimicrobial modules.

Communicate about safe and appropriate use of antimicrobials:

  • Provide regular updates about the AMS program to members of the clinical workforce using different methods, such as newsletters, screensavers, meetings and posters
  • Take part in annual Antibiotic Awareness Week activities
  • Ensure that patients and carers receive current Australian education materials on safe and appropriate use of antimicrobials.

Set up systems for communication about patient care and antimicrobial management with other treating clinicians and caregivers. This is particularly important for transitions of care, and includes internal communication, and external communication with general practitioners, members of the aged care workforce and other prescribers.

Monitor and evaluate the AMS program

Use the quality improvement framework outlined in Action 3.2 to evaluate the AMS program, and identify opportunities and actions for improvement.

Use process and outcome measures to monitor and evaluate the program. Possible process measures include:

Possible outcome measures include:

  • S. aureus bacteraemia–related mortality
  • Infection-related readmissions (for example, joint replacement surgery)
  • Reduced antimicrobial expenditure.

Contribute data on antimicrobial use and appropriateness to relevant programs to enable benchmarking as part of program evaluation. Depending on the type of service, relevant programs could include:

  • Programs undertaken between like services across provider groups
  • State or territory programs
  • National programs such as the Surgical NAPS or NAUSP.

Report on AMS program processes and outcomes

Responsibility for monitoring the effectiveness of the AMS program and ensuring accountability for actions lies with the governing body of the organisation. The governing body also has a role in allocating resources to achieve program goals and outcomes.

Provide a report every year to the chief executive and governance units that summarises:

  • Current AMS resources
  • AMS team activity
  • Performance against process and outcome indicators for antimicrobial use, appropriateness and resistance
  • Key areas of improvement
  • Areas for further improvement or priority
  • Areas in which guidance or support from the chief executive and the governing body is needed.

Refer to Antimicrobial Stewardship in Australian Hospitals and hospitals tab for more detailed implementation strategies for this action.

Examples of evidence

Select only examples currently in use:

  • Committee and meeting records in which compliance with the AMS policy, and antimicrobial prescribing and use were discussed, including reviews of surveillance data
  • Results of analysis of surveillance data on antimicrobial resistance and use
  • Results of NAPS or other audits and surveys about appropriateness of prescribing
  • Improvement activities for AMS that have been implemented and evaluated
  • Communications with clinicians on antimicrobial use, resistance and stewardship in the health service organisation.

MPS & Small Hospitals

Monitoring and analysis of antimicrobial use are critical to understanding patterns of prescribing, the impact on patient safety and antimicrobial resistance, as well as to measure the effectiveness of, and identify means to improve, the AMS program. Antimicrobial use can be measured in terms of quantity, quality (that is, appropriateness of prescribing according to guidelines) or expenditure.

MPSs or small hospitals that are part of a local health network or private hospital group should adopt or adapt and use the established process for monitoring, evaluating and reporting on the organisation’s antimicrobial stewardship program.

Small hospitals that are not part of a local health network or private hospital group should:

  • Collect and regularly review data on antimicrobial use (volume and appropriateness) and local resistance to identify areas for improvement and ascertain the effectiveness of AMS interventions
  • Monitor quality indicators to assess prescribing practice and AMS program effectiveness
  • Use the results of monitoring activities to decide on priorities and actions for improvement
  • Set up a system that ensures that feedback is provided to prescribers on results of monitoring and assessment activity
  • Report routinely to the organisational governing body and the chief executive on AMS processes and outcomes.

Take part in state or territory, or national programs to monitor antimicrobial use and appropriateness that provide readily accessible audit and monitoring tools. Examples are:

Support the AMS team to:

  • Use data on prescribing and antimicrobial use to give feedback to clinicians and clinical teams on prescribing appropriateness, as part of AMS team or pharmacy rounds
  • Publish reports on antimicrobial use and appropriateness.

Implement or review clinical pathways for specific infections or conditions. Ensure that clinical pathways include steps to allow appropriate investigations, routine review of therapy, de-escalation, intravenous-to-oral switch and limiting the duration of therapy.

Set up clinical pathways for common, high-volume and high-risk conditions; examples might include Staphylococcus aureus bacteraemia, bone and joint infections, community-acquired pneumonia, surgical prophylaxis, sepsis and antimicrobial-related allergy.

Use state or territory, or national guidelines or resources to implement a formal intravenous-to-oral switch program.

Require all new prescribers to complete the NPS MedicineWise antimicrobial modules.

Communicate about safe and appropriate use of antimicrobials:

  • Provide regular updates about the AMS program to members of the clinical workforce using different methods, such as newsletters, screensavers, meetings and posters
  • Take part in annual Antibiotic Awareness Week activities
  • Ensure that patients and carers receive current Australian education materials on safe and appropriate use of antimicrobials.

Monitor and evaluate the AMS program using process and outcome measures such as:

  • Antimicrobial Stewardship Clinical Care Standard indicators
  • Indicators to support Antimicrobial Stewardship (AMS) programs
  • Infection- or antimicrobial-related incidents (for example, sentinel events such as S. aureus bacteraemia, or adverse events relating to antimicrobial administration or dosing)
  • S. aureus bacteraemia–related mortality
  • Infection-related length of stay (for example, central line-related sepsis, ventilator-related complications, multidrug-resistant organism infections)
  • Infection-related readmissions (for example, joint replacement surgery)
  • Reduced antimicrobial expenditure.

Report on AMS program processes and outcomes

Report at least annually to the chief executive and relevant governance committees on:

  • AMS resources
  • AMS team activity
  • Performance against process and outcome indicators for antimicrobial use, appropriateness and resistance
  • Key areas of improvement
  • Areas for further improvement or priority
  • Areas in which guidance or support from the chief executive and governing committees is needed.

Refer to the Options for Implementing Antimicrobial Stewardship in Different Facilities resource for examples of monitoring and reporting activities in different settings.