Five essential activities for all hospitals
The Australian Commission on Safety and Quality in Healthcare recommends five essential and four additional activities for antimicrobial stewardship in Australian hospitals as detailed below:
Five Essential Activities for all Hospitals:
- Implementation of clinical guidelines that are consistent with national guidelines and which take into account local microbiology and antimicrobial susceptibility patterns
- Establishing formulary restriction and approval systems that include restriction of broad-spectrum/later generation antimicrobials to patients in whom their use is clinically justified
- Reviewing antimicrobial prescribing with intervention and direct feedback to the prescriber—this should, at a minimum, include intensive care patients
- Monitoring performance of antimicrobial prescribing by collecting and reporting unit or ward-specific use data, auditing antimicrobial use, and using quality use of medicines indicators
- Ensuring the clinical microbiology laboratory uses selective reporting of susceptibility testing results that is consistent with hospital antimicrobial treatment guidelines.
Four antimicrobial stewardship activities that may be considered desirable according to local priorities and resources:
- Education of prescribers, pharmacists and nurses about good antimicrobial prescribing practice and antimicrobial resistance
- Using point-of-care interventions, including streamlining or de-escalation of therapy, dose optimisation or parenteral (IV)-to-oral conversion
- Using information technology such as electronic prescribing with clinical decision support or online approval systems
- Annually publishing facility-specific antimicrobial susceptibility data.
© UoD and BSAC