Using prescribing quality indicators

We will now consider how to use the quantitative data on patterns of antibiotic use along with the information about quality of antibiotic use to develop prescribing indicators to drive improvements in practice.

Antimicrobial prescribing indicators are explicitly defined measureable items of antibiotic use giving a possible indication of the level of quality. They can allow trends to be measures across time, between locations and before/after interventions. There are three main types of indicators – structural, process and outcome.

Structural indicators measure whether governance structures are in place for stewardship such as does a hospital have an Antimicrobial Team which meets regularly, reports to senior management and has an action plan.

Process indicators measure systems in place for stewardship such as a surveillance programme for antibiotic use, a programme of audits, education for healthcare staff.

Outcome measures are used to measure the impact of a stewardship programme and should include both intended and unintended outcomes such as reduced use of restricted antibiotics (intended) and increase in resistance to recommended antibiotics (unintended).

Suitable indicators for stewardship are suggested within the Public Heath England Start Smart Then Focus publication which you may find useful.