Choosing the best strategy

Choosing the appropriate strategy for your healthcare facility – either pre-prescription authorisation or prospective audit and feedback – is something that must be discussed by the AMS committee and can be adapted. More than one strategy can be adopted, but it is usually best to introduce them in a step-wise manner to improve acceptance and compliance.

The following examples illustrate how the approaches differ:

• Prescription of carbapenems:
  • Pre-prescription authorisation: Restrict the use of all carbapenem antibiotics until authorisation by the pharmacist, microbiologist or similar, according to local guidelines.
  • Prospective audit and feedback: Regular bedside ward rounds by the AMS team to review prescription charts for carbapenems and other reserve antibiotics.
• Prescription of individual drugs:
  • Pre-prescription authorisation: Require clear diagnosis before release of ceftriaxone by pharmacist.
  • Prospective audit and feedback: Regular chart reviews and feedback by the pharmacist to check that doses are correct, and the indication and duration are clearly recorded. Courses of antimicrobials lasting more than seven days, without a clear indication for prolonged treatment, are discussed with the prescribing clinician.