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Health care  –  Set up a program


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 personnel that were not targeted in the pilot. 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.

More resources can also be found under RATIONAL USE – Interventions.

Selected Resources


Resource Description
Antimicrobial stewardship programmes in health-care facilities in low- and middle-income countries – a WHO practical toolkit Guidelines from WHO. Chapter 5 covers the process of performing antimicrobial stewardship interventions in healthcare facilities.

See also Module 4 in WHO’s online training course. 

Guidelines for the Prevention and Containment of Antimicrobial Resistance in South African Hospitals Example guidelines to implement antibiotic stewardship and infection prevention for hospitals. Intended for health care professionals in their day-to-day management of resistance. The guidelines build on international guidances and interventions that have been shown to be successful. Customized for South African hospitals based on local experiences. To be used together with Guidelines on Implementation of the Antimicrobial Strategy in South Africa that provides guidance on governance.
Implementation resources for hospitals Information portal with stewardship implementation resources from the US CDC, such as Urine Culture Stewardship in Hospitalized Patients and tools for tracking and reporting. See also Implementation Resources for Outpatient Facilities. and Implementation of Antibiotic Stewardship Core Elements at Small and Critical Access Hospitals.
Guidelines, tools and implementation methods for antibiotic stewardship Information portal that provides support for implementation of antibiotic stewardship divided by levels of care (hospital/primary care/long-term care). By the European Union Joint Action on Antimicrobial Resistance and Healthcare-Associated Infections (EU-JAMRAI).
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 and surveys. Also provides links to useful additional documents.
Guidelines for Implementation of Pharmaceutical and Therapeutics Committees in Gauteng Province Manual from SIAPS that aims to support implementation of pharmaceutical and therapeutic committees (PTCs). Points to the importance of governance structures. Contains numerous example templates and forms, including  generic terms of reference for provincial, district and hospital PTCs (Annex A-C), reporting template for local PTCs (Annex J) and checklist tool for guiding formulary decision making (Annex O). Developed for the Gauteng province in South Africa but could be useful elsewhere.
Step-by-step approach for development and implementation of hospital and antibiotic policy and standard treatment guidelines Document with information on different strategies for implementation of standard treatment guidelines. It also describes how to develop a practical hospital antibiotic policy (WHO Regional Office for South-East Asia).
Toolkit: Implementation of Best Practice Guidelines, Second Edition This Toolkit was designed to assist health care settings in maximizing the potential of clinical practice guidelines, through systematic and well-planned implementation, developed by the Registered Nurses’ Association of Ontario (RNAO).

Achieving sustainable change

Resource Description
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.
The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement The Breakthrough Series is designed to help create a structure in which interested organizations can easily learn from each other and from recognized experts in topic areas where they want to make improvements.
NHS Guide to Sustainability Guide that provides practical advice for health care leaders to implement and sustain improvement initiatives aiming for increased quality and patient experience at lower cost.
Enhancing Project Spread and Sustainability, NSW Clinical Excellence Commission Guide (PDF) This guide aims to provide helpful tips and practical advice to clinicians and health managers on how to improve and assess the spread and sustainability of clinical practice improvement projects in a systematic way.
Nine steps for developing a scaling-up strategy Guide that aims to facilitate systematic planning for scaling up (WHO & ExpandNet).


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