How To Ensure a High Level of Accountability and Prioritisation in Your Organisation

There are important steps to take when developing an antimicrobial stewardship programme (ASP) to ensure tasks are prioritised and followed through with.

When developing an antimicrobial stewardship programme, it is important to have all key members of staff involved in the initial and subsequent meetings. This is for two reasons:

1. Everyone has received the same information and therefore understands why the programme is being set up, and what it consists of
2. Key staff members may have vital information or viewpoints which can be considered – this means everyone’s views are heard, and individuals can explain their decision-making process to ensure the most important points are addressed

Engaging senior leaders in AMS is a core element of Hospital ASPs, to ensure the initiatives are supported and to increase the likelihood of their success and sustainability. Members of the team should have dedicated roles within the programme and be held accountable by senior leaders. To ensure those in leadership roles are invested in the development of a successful ASP, it is important to focus on the value antimicrobial stewardship brings to the institution in order to highlight the need for services.

Important leaders to engage in AMS programmes are:

• Chief Nursing Officer
• Director of Pharmacy
• Director of Patient Safety
• Director of Quality Improvement

In order to ensure tasks are prioritised and carried out, an important step is to set goals and action plans. Setting SMART goals gives clear lines of action which must be taken and assists in planning how they will be met.

To begin with, setting goals for ‘low hanging fruits’ is advisable – these are goals which are more attainable to start with, rather than beginning with very complex issues. They tend to require fewer resources, and will vary from institution to institution.

To meet these goals, tasks must be appointed to relevant individuals and they must be responsible for ensuring they are completed. It is important that there is a collective sense of responsibility in stewardship programmes: it is vital to work as a team and not as an individual.

After the programme has been established, it is important to regularly carry out measurements and collect data (you can find out more about measurements later this week). Building data collection into daily practice means the information is continuously updated and is not forgotten about.

Having data available means it is a simpler process to map your progress, and feedback meaningful data to senior leaders and staff. This can include information on infection and mortality rates before and after improvement measures were put in place – this illustrates the direct effect of the actions taken and makes it clear that changes can make a difference. Circulating the data via a monthly email to all colleagues ensures everyone is aware of what actions are being taken and the effects produced, which adds to the collective sense of responsibility.

Effective communication with all involved is key to keeping everyone on track.

In the comments below, provide:

• Examples of SMART goals which may be appropriate for your setting
• Examples of ‘low-hanging fruit’ interventions