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Health care  –  Set up a program

Implement

Here you can find tools and resources to help implement rational use of antibiotics efforts.

At this stage in the process, the hands on work begins to implement the rational use/stewardship effort. Interventions can be piloted to test their effectiveness and adjusted as needed. Later they can be scaled up or replicated in other settings.

Pilot interventions

No matter how much planning is done, it is difficult to know how well an implementation will go in real life. Unforeseen problems can arise and the needs or resources can rapidly change. The Model for Improvement developed by the Institute for Healthcare Improvement can help to ensure that interventions are aligned with the overall aims and objectives. The model starts with asking key questions about the work to be undertaken and proceeds through a Plan-Do-Study-Act cycle to test ideas. By piloting an intervention with the PDSA cycle, the committee can test the impact of theory put into practice and make adaptations as necessary.

PDSA cycle
Figure 1. Plan-Do-Study-Act cycle adapted from Institute for Healthcare Improvement .

Plan-Do-Study-Act (PDSA):

P   Plan – prepare an action plan for implementation

D   Do – trial the actions in a specific unit or area, or with a certain group of patients

S   Study – compare the baseline and progress measures

A   Act – take action depending on the results  – continue with the trial in one unit or spread your implementation plan to other areas

Scale up interventions

Pilot projects can be scaled up in time, size or breadth of their reach. The length of time can be extended, a project can be implemented in additional units or departments, or they can reach out to additional personal that were not targeted in the first approach. Challenges may arise when scaling up interventions that did not exist in the original iteration. As with any implementation, the context and setting should always be considered and adjustments made appropriately.

Selected Resources

Resource Description
Containing Antimicrobial Resistance: Guide for USAID Missions to Promote Institution-Based Interventions Hands-on guide on how to work with antimicrobial resistance in institutional settings. The guide includes suggestions for interventions with rationales, activities and measurable indicators.
Guidelines on Implementation of the Antimicrobial Strategy in South Africa: One Health Approach & Governance Example implementation guideline. ‘How to’, step-by-step guide for South African healthcare and veterinary workforce to enact the national strategy, addressing the governance framework at different levels of the health system.
National Quality Partners Playbook: Antibiotic Stewardship in Acute Care Framework. Practical strategies for implementing antibiotic stewardship programs in hospitals. The Playbook helps hospitals strengthen existing antibiotic stewardship initiatives or create new programs from the ground up. It is a complimentary resource to the US CDC’s Core Elements of Hospital Antibiotic Stewardship Programs.
Implementation of Antibiotic Stewardship Core Elements at Small and Critical Access Hospitals Framework with example strategies that aims to help implementation of the Core Elements of Hospital Antibiotic Stewardship Programs (from the US CDC) in small and critical access hospitals.
Developing, Implementing, and Monitoring the Use of Standard Treatment Guidelines: A SIAPS How-to Manual Tool for developing and assessing use of standard treatment guidelines. End of document contains sample forms/surveys etc (have a closer look). Also provides links to useful additional documents.
Step-by-step approach for development and implementation of hospital and antibiotic policy and standard treatment guidelines Document containing information on different strategies for implementation of standard treatment guidelines. It also describes the mechanism to develop a practical hospital for standard treatment guidelines and antibiotic policy.
How to Improve, Institute for Healthcare Improvement Model used very successfully by hundreds of health care organizations in many countries to improve many different health care processes and outcomes.
ExpandNet-Who Nine Step Guide published, WHO Guide that aims to facilitate systematic planning for scaling up.

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