• Australian Commission on Safety and Quality in Health Care, Standard 24/12/2020

The Australian Commission on Safety and Quality in Health Care has produced the Antimicrobial Stewardship (AMS) Clinical Care Standard indicators to assist with local implementation of the AMS Clinical Care Standard. The AMS Clinical Care Standard provides guidance to clinicians and health service managers on delivering appropriate care when prescribing antimicrobials. It was first published in 2014 and was updated in 2020 following a review of current evidence and consultation with clinical experts and key organisations.

The goals of the AMS Clinical Care Standard are to ensure:

• The appropriate use and review of antimicrobials to optimise patient outcomes, lessen the harms of adverse effects and reduce the emergence of antimicrobial resistance
• That a patient receives optimal antimicrobial therapy for the treatment or prevention of an infection, including assurance when an antimicrobial is not needed. This means using the right antimicrobial to treat the condition, at the right dose, at the right frequency, by the right route of administration, at the right time and for the right duration, based on accurate assessment and timely review.

The quality statements that are included in the AMS Clinical Care Standard are as follows:

1. Life-threatening conditions- A patient with a life-threatening condition due to a suspected infection receives an appropriate antimicrobial immediately, without waiting for the results of investigations.
2. Use of guidelines- When a patient is prescribed an antimicrobial, this is done in accordance with the current Therapeutic Guidelines or evidence-based, locally endorsed guidelines and the antimicrobial formulary.
3. Adverse reactions to antimicrobials- When an adverse reaction (including an allergy) to an antimicrobial is reported by a patient or recorded in their healthcare record, the active ingredient(s), date, nature and severity of the reaction are assessed and documented. This enables the most appropriate antimicrobial to be used when required.
4. Microbiological testing- A patient with a suspected infection has appropriate samples taken for microbiology testing as clinically indicated, preferably before starting antimicrobial therapy.
5. Patient information and shared decision making- A patient with an infection, or at risk of an infection, is provided with information about their condition and treatment options in a way that they can understand. If antimicrobials are prescribed, information on how to use them, when to stop, potential side effects and a review plan is discussed with the patient.
6. Documentation- When a patient is prescribed an antimicrobial, the indication, active ingredient, dose, frequency and route of administration, and the intended duration or review plan are documented in the patient’s healthcare record.
7. Review of therapy- A patient prescribed an antimicrobial has regular clinical review of their therapy, with the frequency of review dependent on patient acuity and risk factors. The need for ongoing antimicrobial use, appropriate microbial spectrum of activity, dose, frequency and route of administration are assessed and adjusted accordingly. Investigation results are reviewed promptly when they are reported.
8. Surgical and procedural prophylaxis- A patient having surgery or a procedure is prescribed antimicrobial prophylaxis in accordance with the current Therapeutic Guidelines or evidence-based, locally endorsed guidelines. This includes recommendations about the need for prophylaxis, choice of antimicrobial, dose, route and timing of administration, and duration.