Antimicrobial Stewardship Policy

Version 1.3 approved 10 March 2022

The purpose of the Antimicrobial Stewardship Policy (PDF 413KB) is to establish the basis for antimicrobial stewardship (AMS) within SA Health facilities by:

  • Promoting the safe, responsible and appropriate prescribing of antimicrobials as a key element of preventing emergence of antimicrobial resistance and appropriately treating healthcare associated infections
  • Establishing the principles for effective implementation of systems to support the governance, implementation and monitoring of AMS in SA Health facilities
  • Describing the roles and responsibilities of employees of health service organisations in ensuring the safe, effective and appropriate use of antimicrobials.

This policy directive is to be read in conjunction with the SA Health Antimicrobial Prescribing Clinical Guideline (PDF 357KB).

Applicability

This policy applies to all employees and contracted staff of SA Health; that is all employees and contracted staff of the Department for Health and Wellbeing, Local Health Networks (including state-wide services aligned with those Networks1) and SA Ambulance Service.

Specific responsibilities are provided below.

Local Health Network (LHN) Chief Executive Officers

Local Health Network (LHN) Chief Executive Officers will:

  • assign responsibility for AMS to an appropriate delegate of the LHN management team;
  • ensure responsibility for leadership and governance of antimicrobial stewardship is delegated to the AMS committee relevant to the LHN clinical governance structure;
  • ensure adequate resources and training are available for the implementation of this policy throughout the LHN;
  • maintain an effective mechanism for review of antimicrobial stewardship within the LHN;
  • ensure the LHN meets standards for accreditation in relation to antimicrobial stewardship.

Roles of the SA expert Advisory Committee on Antimicrobial Resistance

  • Providing governance over the use of antimicrobial agents as per their Terms of Reference;
  • Advise on, promote, lead the development of, and review statewide prescribing guidelines and factsheets on antimicrobial use;
  • Provide advice on the appropriate use of antimicrobial drugs to relevant SA Health committees or practice areas with responsibility for developing guidelines, conducting research, formulary management or other activity impacting antimicrobial use in South Australia;
  • Consult with relevant local and national organisations regarding the promulgation and implementation of policies and guidelines for antimicrobial use in South Australia;
  • Review South Australian antimicrobial usage and multi-resistant organism surveillance data and advise on emerging trends and suggest appropriate interventions.

LHN AMS Committees

LHN AMS Committees are responsible for:

  • providing leadership for addressing requirements of the LHN relating to meeting the national standards related to AMS for accreditation;
  • working collaboratively with other LHN committees, such as Drug and Therapeutics Advisory Committees and Infection Prevention and Control Committees, regarding formulary management and AMS issues as necessary;
  • providing representation for the LHN on the SA expert Advisory Group for Antimicrobial Resistance (SAAGAR) and other relevant statewide committees;
  • reviewing and providing input to the development of LHN guidelines on antimicrobial use where required;
  • contributing to established national surveillance programs to monitor the appropriateness of antimicrobial use;
  • coordinating actions in response to results of surveillance of antimicrobial use;
  • providing leadership for the training of clinical staff throughout the LHN in relation to AMS.

Prescribers

Prescribers (including contracted staff) are responsible for:

  • safe and appropriate prescribing and therapeutic monitoring of antimicrobials;
  • ordering timely and relevant pathology tests and reviewing results to promote safe and appropriate prescribing;
  • accessing relevant locally developed and approved guidelines or using the latest version of the Australian Therapeutic Guidelines: Antibiotic (TG) as part of their practice;
  • documenting the reason for antimicrobial therapy and its expected duration or point of review on the medication chart or case notes;
  • maintaining a work ethic that is in keeping with the principles of antimicrobial stewardship and the controls introduced by their LHN as part of the local AMS program. Where relevant, this involves seeking and documenting of expert advice on the management of infection, and approval for the use of restricted antimicrobials as required;
  • provision of information to patients and their carers regarding their antimicrobial therapy and the systems to promote antimicrobial stewardship within SA Health.

Pharmacists

Pharmacists (including contracted staff) are responsible for:

  • working collaboratively with prescribers to support AMS principles;
  • timely and accountable supply of antimicrobials in accordance with systems introduced by the LHN AMS program, including mechanisms to control access to restricted antimicrobials (where restrictions exist);
  • safe, appropriate, and timely advice to prescribers and nurses with regard to the selection, dose, route, duration, and monitoring of antimicrobials;
  • checking that restricted antimicrobials are accompanied by the appropriate approval documentation prior to their administration;
  • provision of information to patients and their carers regarding their antimicrobial therapy and the systems to promote AMS within SA Health.

Nurses

Nurses are responsible for:

  • working collaboratively with prescribers to support AMS principles;
  • ensuring safe and timely administration of prescribed antimicrobials;
  • supporting timely collection and review of pathology specimens;
  • being familiar with the principles of AMS and related systems within their LHN and supporting antimicrobial stewardship within SA Health;
  • where it is within their scope of practice, checking that restricted antimicrobials are accompanied by the appropriate approval documentation prior to their administration and seeking advice from relevant prescribers and pharmacists if the appropriate documentation is missing;
  • assisting patients and carers to obtain information and understanding of their antimicrobial therapy.

Notes

1 — ‘Statewide services’ includes Statewide Clinical Support Services, Prison Health, SA Dental Service, BreastScreen SA and any other state-wide services that fall under the governance of the Local Health Networks