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Health care  –  Set up a program

Assess the situation

An initial situational assessment of how antibiotics are currently being used will serve both to identify areas for improvement and also to supply baseline information against which to compare findings from later evaluations.

The type of assessment depends on the resources available and the scope of the program or intended interventions.

Assess existing or generate new data

Antibiotic resistance: As antibiotic resistance develops and spreads, antibiotics that were once used may no longer be effective against bacteria. The clinical microbiology laboratory is responsible for identifying organisms, genotyping and determining if bacteria are susceptible, or sensitive to antibiotics. Susceptibility testing also provides input into the development of treatment guidelines which should be done at the local level and repeated regularly. See MEASURE: Antibiotic resistance.

Consumption of antibiotics: Monitoring and analysis of antibiotic use is one of the main objectives of a rational use program. Health care facilities should regularly review which prescriptions are being written and which drugs are actually being consumed. See MEASURE: Consumption.

Appropriateness of use: It is important to know if the right antibiotic is being used for the right indication. One method is to review patient medical records, using prevalence surveys to get a snapshot of prescribing practices, another is to use clinical audits. See MEASURE: MEASURE: Appropriate use.

Quality of antibiotics: Administration of low-quality antibiotics can have detrimental effects on patient health and can lead to the spread of resistance. Methods for detecting such quality issues exist and should be incorporated into rational use initiatives. See MEASURE: Quality.

Knowledge, attitudes, behaviors and perceptions: The view prescribers have on rational use can provide insight to accompanying use data and inform behavior change interventions. See MEASURE: KABP

Understand barriers, facilitators and readiness for change

A successful implementation can be enabled or hindered by policies and guidelines, individual responsiveness or level of organizational support. Brainstorming, interviews, focus groups, observations or surveys can be used to help understand the barriers and facilitators to developing effective programs and interventions.

While change can be easy and exciting for some, others find it daunting and can be skeptical of the positive impact it can make. Readiness for change is about being open to something new and willingness to sustain initiatives over time. Receptiveness to change is dependent on strong leadership, clear vision, and good management.

Selected Resources

Resource Description
Checklist Core Elements of Hospital Antibiotic Stewardship Programs This document provides the reader with a checklist of Core Elements of Hospital Antibiotic Stewardship Programs developed by the Centers for Disease Prevention and Control. It is a companion to Core Elements of Hospital Antibiotic Stewardship Programs.
Antimicrobial self-assessment toolkit (ASAT) for acute hospitals Antimicrobial Stewardship toolkit that offers a checklist for hospitals to self-assess their organizations’ levels of antimicrobial stewardship.
How to Investigate Antimicrobial Use in Hospitals: Selected Indicators This manual defines indicators to help assess the management and use of antibiotics in hospitals and provides tools and step-by-step instructions for designing and carrying out assessment activities. Also available in French and Spanish.
Joint External Evaluation Tool (JEE Tool): International Health Regulations (2005) WHO and Global Health Security Agenda (GHSA) tool to measure progress towards capacity building for preventing, detecting, and responding to infectious disease threats, including antimicrobial resistance. The evaluation tool is designed for use at the country level and suggests indicators. It has been tested in a number of GHSA-affiliated countries (examples can be accessed on the same page).
Identifying barriers to evidence uptake, Australia (PDF) This guide provides practical help to health professionals who want to improve evidence uptake. It provides an overview of types of barriers that may impede improvement and some examples of potential barriers.

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