Applying AMSP in the hospital setting can be a difficult process initially, wherein the physicians have to change their patterns of prescriptions, and the patient has to handle the burden of the cost of culture sensitivity testing. Yet, starting this itself is an important part; eventually, it settles in within the system.
In this process, we must remember to start smart.
- Take a history of relevant allergies
- Initiate prompt, effective antibiotics within one hour of diagnosis or as soon as possible
- Comply with local prescribing guidelines, which are made keeping the local resistance patterns in mind
- Document clinical indication and dose on the drug chart and clinical notes
- Include review/stop date or duration, IV/oral switch, change to narrow spectrum, OPAT, etc.
- Ensure relevant microbiological specimens are taken
- Define clinical situations wherein antibiotic treatment can be stopped, and the duration of therapy must be reviewed
AMSP Team: Roles and Responsibilities
- Physician leader with ID training
- Co-led by a pharmacist leader with ID training
- Clinicians and HODs – Prescriber-led
- Infection preventionists or hospital epidemiologists – Monitor, audit, analyze and report facility-wide data
- Quality management staff – Medical quality and patient safety issues
- Microbiology lab – Antibiograms to guide empiric therapy
- IT staff – Integrate stewardship protocols into existing workflow
- Nurses – Ensure cultures are taken before starting antibiotics
Keys to the Success of AMSP
- Clear aim/vision that stewardship is a “Patient safety” priority
- Management support and accountability
- Multi-professional AMS team with a strong, influential clinical leader
- Effective communication structures
- Evidence-based stewardship interventions and planned measurement
- Education and innovation
- Ensure early or short-term wins and then consolidate success/gains
MBH/AB