Antimicrobial stewardship (AMS) in hospitals

In Australia, national safety and quality standards require all hospitals to have an effective antimicrobial stewardship (AMS) program in place, which is assessed for accreditation. An AMS program encompasses all the activities that promote and monitor appropriate prescribing of antimicrobials within an organisation. The AMS program should be part of the organisation’s quality improvement and patient safety governance structure; it is generally managed by a committee.

Dedicated staff resources are required to carry out AMS activities in a hospital. Ideally, this work is done by a multidisciplinary team including a lead doctor and pharmacist. In smaller facilities, if a team is not available, the staff responsible for AMS may be supported by offsite clinicians with relevant expertise. Part of the role of an AMS service is to ensure that ongoing education and training about infection management, antimicrobial resistance and optimal antimicrobial use is provided for health professionals and consumers. AMS services also monitor prescribing practices to identify problems, document improvements and provide resources to prescribers to promote optimal antimicrobial use.

Ongoing review of AMS programs should be undertaken to assess the impact of interventions.

The Antimicrobial Stewardship Clinical Care Standard produced by the Australian Commission on Safety and Quality in Health Care (ACSQHC) includes 8 quality statements for effective AMS in hospitals; see Eight quality statements for effective antimicrobial stewardship in hospitals.

Measuring the appropriateness of antimicrobial prescribing is a key focus of AMS programs. The National Centre for Antimicrobial Stewardship (NCAS) coordinates and delivers the National Antimicrobial Prescribing Survey (NAPS), a standardised auditing tool to assess the appropriateness of local antimicrobial prescribing.

Table 1. Eight quality statements for effective antimicrobial stewardship in hospitals
Australian Commission on Safety and Quality in Health Care (ACSQHC), 2024
Quality statement	Actions to be considered
Life-threatening conditions	A patient with a life-threatening condition due to a suspected infection receives antimicrobials in a timely manner (ie without waiting for the results of investigations)
Use of guidelines	When a patient is prescribed an antimicrobial, this is done in accordance with Therapeutic Guidelines: Antibiotic, evidence-based guidelines, local protocols and the antimicrobial formulary
Adverse reactions to antimicrobials	If an adverse reaction (including allergy) to an antimicrobial is reported by a patient, the active ingredient, date, nature and severity of the reaction are assessed and documented
Use microbiological testing or diagnostic tests	A patient with a suspected infection has appropriate samples taken for microbiology testing as clinically indicated, preferably before starting antimicrobial therapy Clinical microbiology service: provides guidance and support for optimal sample collection targets reporting of clinically meaningful pathogens and their susceptibilities uses selective reporting of susceptibility test results generates location-specific antimicrobial susceptibility reports (antibiograms) annually
Patient information and shared decision making	A patient with an infection (or at risk of an infection) is provided with information about their condition and treatment options If antimicrobials are prescribed, information on how to use them, when to stop, potential adverse effects and a review plan is discussed with the patient
Documentation	Document the indication, active ingredient, dose, frequency, route of administration and intended treatment duration or review plan in the patient’s healthcare record
Review of therapy	A patient prescribed an antimicrobial has regular clinical review of their therapy, with the frequency of review dependent on severity of illness and risk factors The need for ongoing antimicrobial use, appropriate microbial spectrum of activity, dose, frequency and route of administration are assessed and adjusted as required Investigation results are reviewed promptly
Surgical and procedural prophylaxis	Surgical antimicrobial prophylaxis is prescribed in accordance with Therapeutic Guidelines or evidence-based, locally endorsed guidelines Guideline recommendations should include the need for prophylaxis, choice of antimicrobial, dose, route and timing of administration, and duration
Note: Reproduced with permission from Antimicrobial Stewardship Clinical Care Standard (2020), developed by the Australian Commission on Safety and Quality in Health Care (ACSQHC). ACSQHC: Sydney 2020.