Skip main navigation

Metrics for AMS Programme Evaluation

Learn more about metrics for AMS programme evaluation.
'Evaluation' written on chalkboard

One of the most commonly used metrics to evaluate antimicrobial stewardship programs (ASP) is antimicrobial consumption metrics which is discussed in the previous step. In this step, we will discuss the qualitative measures (or metrics) that can be used to evaluate ASP. As briefly mentioned in step 2.14 these can be divided into the structure, process, and outcome metrics.

Structural metrics evaluate whether governance structures are in place for the antibiotic stewardship program. Things to consider include:

  • What is the availability of a formal antibiotic stewardship team (AST)?

• Does the AST meet regularly?

• Are local protocols available and updated annually?

• Does the AST include certain staff (microbiology lab, nursing, ICU head, IT)?

• Is an antibiogram available and updated annually?

• Do you distribute updated antibiograms to prescribers every year?

• Is there a regular AST ward round?

• Is there a list of restricted antimicrobials?

Process metrics evaluate systems in place for the program. Examples of ways to measure this include:

  • Percentage of adherence to documenting the indication
  • Number of ASP interventions

• Acceptance of ASP recommendations

• Awareness of local antibiotic policy

• Percent of compliance with the guidelines

• Percent of patients receiving appropriate antibiotics

• Indication documentation

• De-escalation frequency

• Percent of IV to PO switch

• Appropriate discontinuation time of surgical antibiotic prophylaxis

• Time to appropriate antibiotic levels

• Percentage of appropriate cultures obtained before starting antibiotics

Outcome metrics can measure clinical outcomes such as:

• Infection cure

• Mortality (all-cause? 30-day? in-hospital mortality?)

• Re-admissions (30-day?)

• Length of stay

• Surgical site infections

C. difficile infections

• Antibiotic resistance (which microbe and which antimicrobial?)

• Adverse drug reactions

• What are the costs (direct and indirect)?

The clinical outcomes are generally not easy to collect. The outcome metrics could also be microbiological such as the percentage of Pseudomonas resistance to meropenem.

Some concerns with resistance as a metric are that there are many confounding variables, including infection control activities, they are not immediately sensitive to change, and we have to consider breakpoint changes over time.

In addition, when resistance is reduced with a reserved agent, resistance could increase with recommended agents.

Do you currently carry out any qualitative measures of antibiotic consumption in your healthcare setting? If yes, what measures do you use?

This article is from the free online

Antimicrobial Stewardship for the Gulf, Middle East and North Africa

Created by
FutureLearn - Learning For Life

Our purpose is to transform access to education.

We offer a diverse selection of courses from leading universities and cultural institutions from around the world. These are delivered one step at a time, and are accessible on mobile, tablet and desktop, so you can fit learning around your life.

We believe learning should be an enjoyable, social experience, so our courses offer the opportunity to discuss what you’re learning with others as you go, helping you make fresh discoveries and form new ideas.
You can unlock new opportunities with unlimited access to hundreds of online short courses for a year by subscribing to our Unlimited package. Build your knowledge with top universities and organisations.

Learn more about how FutureLearn is transforming access to education