Closing summary for this Quick Win

You can implement AS activities successfully in a variety of geographical and socio-economic settings including small community hospitals.

One of the major challenges in this South African example of a quick win was the fact that most hospitals had very limited infectious diseases resources and therefore ways had to be found to use available personnel to perform AS activities. It made sense to choose a pharmacist-driven prospective audit and intervention approach.

Due to the geographic challenges implementing a basic AS program in more than one hospital had to include centralised management of pharmacists, automated data collection and six-weekly teleconferences.

Although developing and implementing a successful AS program is a challenge in any healthcare setting, there are unique challenges to smaller and rural hospitals with limited resources which may hamper the ability to implement ideal sustainable AS strategies.

Hence, an initial AS program should be approached as a step-wise menu of interventions and strategies targeted to institutional needs and resource availability.

Finally, it is also apparent that skills beyond those of infectious diseases and microbiology are critical in starting and maintaining a sustainable AS program. These include:

• an understanding of how to implement change, reflected in this study by the innovative adoption and stepwise application of the IHI’s collaborative model to achieve breakthrough Improvement
• how to effectively use behaviour change techniques (BCTs), such as self-monitoring, feedback combined with goal setting and action plans and
• how to measure the success of implementation, by using quality improvement run chart rules.

You will find papers relating to antimicrobial stewardship in community hospitals in “see also” below.