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Developing an AMS action plan

This article discusses how to develop an AMS action plan, including the core elements.

The next step after undertaking a SWOT analysis is to develop an implementation plan.

This step will include assessing governance structures, the composition of the AMS committee, the availability and role of data and the input of the microbiology laboratory. It is also important to understand the synergistic role of Infection Prevention and Control staff and structures.

Using the WHO healthcare facility core elements checklist

As discussed throughout this course, the healthcare facility core elements checklist, found in Chapter 3 Table 4, is a valuable tool for setting up AMS programmes (ASPs). It can also be used as a means of measuring progress with implementation of the AMS programme. The diagram below shows how to evaluate your programme against each point of the checklist, both when developing and when evaluating your AMS action plan.

Flowchart asking, "Is the core element in place in your facility?". If yes, is it fully or partially implemented? If not, is it a priority?

Click here to see a larger version of this image.

How to develop an AMS action plan

Developing a hospital AMS action programme is not an overnight process. The overall programme may take a couple of years to establish, and must be done in a stepwise manner, building on existing structures. It is crucial to keep the programme realistic, measurable, and with responsibilities assigned.

To achieve this, it is important to set out a strong AMS action plan right from the start. The key components of an action plan are described in the image below.

Key components of an AMS action plan in a healthcare facility. Six text boxes connected with arrows to the title. The boxes are labelled: core elements; governance; AMS activities; facility-wide engagement; budget; education and training.

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This infographic is also available as a screen-reader compatible PDF.

The action plan should focus on the immediate priorities and include details of the financial, human, and IT resources needed to maintain the AMS activities. It should also indicate other healthcare professionals apart from the main AMS team and details of any necessary ward rounds or interventions. There should be an assessment of the existing AMS competencies, with education and training available at the start of the programme as well as further along, to help to optimise antimicrobial prescribing. The plan can be developed and updated as needed incrementally to reflect progress and identify new priorities.  

Example of an action plan

An action plan can be created in the form of a table of activities, timelines, indicators, responsibilities and support required, as in the example below.

Example AMS action plan template table showing a vertical list of activities and a horizontal list of timeline, indicator, responsibility and support required. It mentions the reporting of ASP / PPS interventions.

Click here to see a larger version of this image.

This infographic is also available as a screen-reader compatible PDF.

Another approach to developing an action plan is using a driver diagram.

Driver Diagram

If there is a desire to utilise “quality improvement” methodology to create and execute an AMS action plan then using a ‘driver diagram’ can be helpful. It can be broad covering the overall AMS action plan or specific to a particular intervention.

A driver diagram is a visual display of a team’s theory of what “drives,” or contributes to, the achievement of a project aim. Note this is different to when we discussed the drivers of AMS back in week 1. This clear picture of a team’s shared view is a useful tool for communicating to a range of stakeholders where a team is testing ideas and working on improving practice.

The diagram below displays the ‘drivers’ of a project’s success. It shows how the project’s aim relates to its primary or key drivers and also the secondary drivers, which are the smaller, actionable components of each primary driver.

Click here for an excellent NHS resource for those wanting to learn more about driver diagrams.

Flowchart highlighting the main and secondary goals and the secondary drivers.

Click here to see a larger version of this image.

This infographic is also available as a screen-reader compatible PDF.

The Centre for Disease Prevention and Control (CDC) have an excellent example of an AMS driver diagram with the related range of actions (change package) available here.

Key steps to an action plan

Regardless of how you choose to develop and present it, there are two key steps to developing an action plan.

  1. Identify your high-level goals
  2. Identify how to achieve each of your goals over your time frame (e.g. 2 years): identify activities, responsible personnel, and resources.

AMS teams will need to determine which AMS interventions to test and how they should be implemented in their local context. AMS teams looking to implement or review an existing ASP may find it helpful to contact different hospitals or practices to learn how their ASPs have been developed, what strategies have been selected and what lessons were learned during their implementation.

For strategies to be adopted and accepted by prescribers, they need to fit within the clinical workflow, and their implementation should be carefully planned and endorsed by the hospital management team.

Now it’s your turn! Share your experience of developing an AMS action plan in the comments below. What were the key challenges? What lessons did you learn?

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