New antimicrobial stewardship clinical care standard

---

Antibiotic resistance poses a significant threat to public health because antibiotics underpin routine clinical practice in a variety of healthcare settings. Bacteria can develop resistance to specific antibiotics, meaning that the antibiotic is no longer effective against those bacteria. Although antibiotic resistance is a natural feature of bacterial evolution, inappropriate use of antibiotics has increased the development of antibiotic-resistant bacteria, not only in hospitals and healthcare services but also in the community.^{1, 2}

---

Australia has one of the highest rates of antibiotic use in the developed world, with around 22 million prescriptions written every year in primary care alone. In hospitals, 30 per cent of antibiotics prescribed are used inappropriately. ³
The new Antimicrobial Stewardship (AMS) Clinical Care Standard will reduce inappropriate use of antibiotics, improve patient outcomes and help reduce antimicrobial resistance. The AMS Clinical Care Standard was developed by the Australian Commission on Safety and Quality in Health Care (the Commission) in collaboration with consumers, clinicians, researchers and health service organisations.
Launched in November 2014, the AMS Clinical Care Standard aims to ensure that a patient with a bacterial infection receives optimal treatment with antibiotics. ‘Optimal treatment’ means that patients are treated with the right antibiotic to treat their condition, and that they are given the right dose, by the right route, at the right time and for the right duration, based on accurate assessment and timely review.
The AMS Clinical Care Standard consists of nine quality statements that have been developed for use in a variety of healthcare settings, including hospitals, general practice and residential agedcare facilities.
Quality Statements

1. A patient with a life-threatening condition due to a suspected bacterial infection receives prompt antibiotic treatment without waiting for the results of investigations.


2. A patient with a suspected bacterial infection has samples taken for microbiology testing as clinically indicated, preferably before starting antibiotic treatment.


3. A patient with a suspected infection, and/or their carer, receives information on their health condition and treatment options in a format and language that they can understand.


4. When a patient is prescribed antibiotics, whether empirical or directed, this is done in accordance with the current version of the Therapeutic Guidelines4 (or local antibiotic formulary). This is also guided by the patient’s clinical condition and/or the results of microbiology testing.


5. When a patient is prescribed antibiotics, information about when, how and for how long to take them, as well as potential side effects and a review plan, is discussed with the patient and/or their carer.


6. When a patient is prescribed antibiotics, the reason, drug name, dose, route of administration, intended duration and review plan is documented in the patient’s health record.


7. A patient who is treated with broad-spectrum antibiotics has the treatment reviewed and, if indicated, switched to treatment with a narrow-spectrum antibiotic. This is guided by the patient’s clinical condition and the results of microbiology tests.


8. If investigations are conducted for a suspected bacterial infection, the responsible clinician reviews these results in a timely manner (within 24 hours of results being available) and antibiotic therapy is adjusted taking into account the patient’s clinical condition and investigation results.


9. If a patient having surgery requires prophylactic antibiotics, the prescription is made in accordance with the current Therapeutic Guidelines⁴(or local antibiotic formulary), and takes into consideration the patient’s clinical condition.

The Commission has developed a range of resources for clinicians and health services to assist with implementation of the AMS Clinical Care Standard, including tools for local monitoring and evaluation, and fact sheets for clinicians and patients.
The Commission’s Clinical Care Standard program focuses on reducing the gap between what we know works, based on best available evidence (in terms of procedures, treatments and processes), and what care is actually offered to patients.

---

“The new Antimicrobial Stewardship (AMS) Clinical Care Standard will reduce inappropriate use of antibiotics, improve patient outcomes and help reduce antimicrobial resistance.”

---

References
1. World Health Organization. The evolving threat of antimicrobial resistance: options for action. Geneva: WHO, 2012.
2. Duguid M, Cruickshank M, editors. Antimicrobial stewardship in Australian hospitals. Sydney: Australian Commission on Safety and Quality in Health Care, 2010.
3. Australian Commission on Safety and Quality in Health Care. Antimicrobial prescribing practice in Australia: results of the 2013 National Antimicrobial Prescribing Survey. Sydney: ACSQHC, 2014.
4. Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited, 2014.
For more information, and to download the AMS Clinical Care Standard and resources, visit www.safetyandquality.gov.au/ccs.