Antimicrobial Stewardship Clinical Care Standard

A patient with a life-threatening condition due to a suspected infection receives an appropriate antimicrobial immediately, without waiting for the results of investigations.

Purpose

To ensure access to timely and appropriate antimicrobial treatment for consumers with suspected life-threatening infections that can lead to sepsis*, septic shock, bacterial meningitis, febrile neutropenia or necrotising fasciitis, when clinically appropriate.

* Sepsis as defined by the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).⁴

The Sepsis Clinical Care Standard is available here.

When a patient is prescribed an antimicrobial, this is done in accordance with the current Therapeutic Guidelines or evidence-based, locally endorsed guidelines and the antimicrobial formulary.

Purpose

To ensure that the most appropriate antimicrobial treatment is given. That is, to ensure that the appropriate spectrum microbial of activity, active ingredient, dose, frequency and route of administration, and duration of therapy is chosen.

When an adverse reaction (including an allergy) to an antimicrobial is reported by a patient or recorded in their healthcare record, the active ingredient(s), date, nature and severity of the reaction are assessed and documented. This enables the most appropriate antimicrobial to be used when required.

Purpose

To ensure the accurate assessment and documentation of patient adverse reaction information to allow for optimal antimicrobial prescribing. This means using the most appropriate and narrow-spectrum antimicrobial possible, while ensuring that potential harms (such as anaphylaxis) are avoided.

A patient with a suspected infection has appropriate samples taken for microbiology testing as clinically indicated, preferably before starting antimicrobial therapy.

Purpose

To support appropriate antimicrobial selection with relevant microbiology testing when clinically indicated.

A patient with an infection, or at risk of an infection, is provided with information about their condition and treatment options in a way that they can understand. If antimicrobials are prescribed, information on how to use them, when to stop, potential side effects and a review plan is discussed with the patient.

Purpose

To inform patients about their clinical condition so that they can participate in decision-making about their treatment options in collaboration with their clinician. This may or may not include antimicrobials.

To improve patient understanding on how to take prescribed antimicrobials and to improve concordance with therapy.

When a patient is prescribed an antimicrobial, the indication, active ingredient, dose, frequency and route of administration, and the intended duration or review plan are documented in the patient’s healthcare record.

Purpose

To improve documentation of antimicrobial treatment to support effective communication among clinicians through the patient’s healthcare record. This record may include mechanisms such as paper or electronic healthcare records, the My Health Record system, prescription records or the medication chart. Documentation allows the appropriateness of the prescription to be assessed, and ensures that all clinicians involved in the patient’s care have access to consistent and current information.

A patient prescribed an antimicrobial has regular clinical review of their therapy, with the frequency of review dependent on patient acuity and risk factors. The need for ongoing antimicrobial use, appropriate microbial spectrum of activity, dose, frequency and route of administration are assessed and adjusted accordingly. Investigation results are reviewed promptly when they are reported.

Purpose

To optimise patients’ antimicrobial therapy through clinical assessment and review of the appropriateness of the antimicrobial and of investigation results.

To prevent unnecessary antimicrobial use, including of the use of broad-spectrum antimicrobials where a narrow-spectrum antimicrobial could be used, to reduce the potential to drive antimicrobial resistance.

To ensure the appropriate dosing regimen and route of antimicrobials to adequately treat or prevent an infection, improve patient outcomes and reduce patient harm (for example, when a patient has renal impairment, or when oral options can replace intravenous use). This may include therapeutic drug monitoring.

A patient having surgery or a procedure is prescribed antimicrobial prophylaxis in accordance with the current Therapeutic Guidelines or evidence-based, locally endorsed guidelines. This includes recommendations about the need for prophylaxis, choice of antimicrobial, dose, route and timing of administration, and duration.

Purpose

To reduce the risk of surgical site infections from procedures including surgery, dental procedures, gastrointestinal endoscopic procedures, implantable cardiac device insertions, diagnostic interventions, cleaning and debridement of traumatic wounds, and ophthalmic surgery including cataract removal.

To ensure appropriate antimicrobial prophylaxis, including avoiding the use of antimicrobials when not required.