Antimicrobial stewardship

Note: This action is only applicable if your healthcare service prescribes, supplies or administers antimicrobial medicines. 

Inappropriate use of antimicrobials contributes to the emergence of resistant microorganisms (including bacteria and viruses) and causes patient harm. Patients with antimicrobial-resistant infections are more likely to experience ineffective treatment, recurrent infection, delayed recovery or even death. Antimicrobial stewardship (AMS) is a coordinated set of strategies to improve the appropriateness of use and minimise the adverse effects of antimicrobial use.

The Antimicrobial Stewardship Clinical Care Standard provides guidance to healthcare providers and services on delivering appropriate care regarding antimicrobials. It includes eight quality statements:

• A patient with a life-threatening condition due to a suspected infection receives an appropriate antimicrobial immediately, without waiting for the results of investigations 
• 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
• 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
• A patient with a suspected infection has appropriate samples taken for microbiology testing as clinically indicated, preferably before starting antimicrobial therapy
• 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
• 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
• A patient prescribed an antimicrobial has a 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
• 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.

• How do healthcare providers access current therapeutic guidelines or evidence-based, locally endorsed guidelines at the point of care?   
• How are healthcare providers supported to incorporate core elements, recommendations and principles from the current Antimicrobial Stewardship Clinical Care Standard? 
• What information is communicated to patients when an antimicrobial is prescribed, supplied or administered? How is this information communicated?
• How are data on antimicrobials collected, reviewed and used for improvement action?

• Ensure healthcare providers have access to, and promote, current guidelines for treatment and prophylaxis for common infections relevant to the patient population, the indications for use and the local antimicrobial resistance profile (if known). Information sources include
  • Therapeutic Guidelines: Antibiotic, one of the key national guidelines for antimicrobial prescribing in Australia
  • Health Pathways in a healthcare service’s local Primary Health Network (PHN)
  • Local evidence-based guidelines, where available. 
• Support healthcare providers to incorporate relevant core elements, recommendations and principles from the current Antimicrobial Stewardship Clinical Care Standard, developed by the Commission. 
• Review policies, clinical pathways, point-of-care tools and education programs to ensure that they incorporate the principles of the Antimicrobial Stewardship Clinical Care Standard.
• Collect and regularly review data on antimicrobial against the therapeutic guidelines or local pathways. Indicators specified in the Antimicrobial Stewardship Clinical Care Standard may be helpful. 
• Use this analysis to identify areas for quality improvement and action to be taken. 
• Provide access to and promote resources to educate consumers about the risks, benefits and alternatives to antimicrobials for their condition.

The type and comprehensiveness of evidence used is dependent on each healthcare service context, but could include:

• Observation of healthcare providers accessing electronic or printed copies of endorsed Therapeutic Guidelines: Antibiotic 
• Examples of communication materials provided to patients regarding antimicrobials 
• Guidance for healthcare providers on providing materials to patients regarding antimicrobials 
• Requirements for and/or records of healthcare providers completing NPS MedicineWise antibiotic prescribing modules. 

Commission resources

• Antimicrobial stewardship in primary care – outlines the important task of improving the safe and appropriate use of antimicrobials and reducing patient harm and the risk of antimicrobial resistance. 
• Antimicrobial Stewardship Clinical Care Standard – supports quality improvement by health services and clinicians to help reduce antimicrobial resistance.
• Options for implementation of AMS primary care Aboriginal Community Controlled Health Services – provides guidance for healthcare services to support the implementation of antimicrobial stewardship programs in Aboriginal community-controlled health services.
• Options for implementation of AMS primary care Community Health services – provides guidance for healthcare services to support the implementation of antimicrobial stewardship programs in community health services.
• Options for implementation of AMS primary care Allied Health including Optometry and Podiatry Practices – provides guidance for healthcare services to support the implementation of antimicrobial stewardship programs in allied health.
• Options for implementation of AMS primary care Dental Practice – provides guidance for healthcare services to support the implementation of antimicrobial stewardship programs in dental practice.
• Options for implementation of AMS primary care General Practice – provides guidance for healthcare services to support the implementation of antimicrobial stewardship programs in general practice.
• Options for implementation of AMS in community pharmacies – provides guidance for healthcare services to support the implementation of antimicrobial stewardship programs in community pharmacies.
• Sepsis Clinical Care Standard – ensures that a patient presenting with signs and symptoms of sepsis receives optimal care, from symptom onset through to discharge from hospital and survivorship care.
• Antimicrobial Stewardship in Australian Health Care Book – additional evidence, information, and topic areas to inform antimicrobial stewardship (AMS) strategies, interventions, and implementation across a range of healthcare settings.

Other resource

• Therapeutic Guidelines: Antibiotic prescribing in primary care: Therapeutic Guidelines summary table 2019 – summarises the antibiotic management of common conditions in primary care.