Antimicrobial stewardship: 2b-The proportion of prescriptions for restricted antimicrobials that are in accordance with the locally endorsed approval policy

The proportion of prescriptions for restricted antimicrobials that are in accordance with the locally endorsed approval policy.

For the numerator and denominator, there may be one or more prescriptions for any one patient during an episode of care. All prescriptions meeting the criteria for the numerator or the denominator should be counted.

For the numerator and denominator, ‘restricted antimicrobials’ refers to an antimicrobial that could contribute to the development of multidrug-resistant organisms, has considerable side effects or is expensive, and for which prescribing needs to meet certain criteria.

‘Antimicrobial formulary’ refers to a list of antimicrobial agents approved for use within an organisation or a network that includes descriptions of restrictions and criteria for use.

For the numerator, 'in accordance’ means that the restricted antimicrobial prescription aligns with the antimicrobial formulary conditions, and where applicable, follows the procedures for obtaining approval for the use of restricted antimicrobials outlined in the local policy.

Presented as a percentage.

(Numerator ÷ Denominator) x 100​

Number of prescriptions for a restricted antimicrobial that are in accordance with the locally endorsed approval policy.

Number of prescriptions for restricted antimicrobials.

Restricting the use of antimicrobials through a formulary system with pre- or post-prescription approval is considered an essential component of any hospital antimicrobial stewardship program. In many circumstances, medicines on the formulary have conditions attached to their approval – for example, use for patients with a particular condition, or when other options are contraindicated. Certain antimicrobials may be restricted for use only with approval by nominated expert prescribers, such as infectious diseases physicians or microbiologists.

As per the National Safety and Quality Health Service Standards (2nd ed), health service organisations are required to implement an antimicrobial stewardship policy that lists restricted antimicrobials and procedures for obtaining approval for the use of these antimicrobials.

See the Antimicrobial Stewardship Clinical Care Standard (ACSQHC 2020) for key considerations to optimise the use of antimicrobials.

See Antimicrobial Stewardship in Australian Health Care (ACSQHC 2018) for further information on restricted antimicrobials, formulary and approval processes.

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Applicable settings:

All hospital settings, including public and private hospitals, acute, subacute facilities, outpatient and day procedure services.

Australian Commission on Safety and Quality in Health Care

Australian Commission on Safety and Quality in Health Care. Antimicrobial Stewardship Clinical Care Standard. Sydney: ACSQHC; 2020.

Australian Commission on Safety and Quality in Health Care. Antimicrobial Stewardship in Australian Health Care 2018. Sydney: ACSQHC; 2018

Australian Commission on Safety and Quality in Health Care. National Safety and Quality Health Service Standards. 2nd ed. Sydney: ACSQHC; 2017.