Snapshot of barriers to and indicators for antimicrobial stewardship in Australian hospitals

Effective antimicrobial stewardship programs are vital in an environment of emerging resistance to existing antimicrobials and the limited availability of new antimicrobials. There are institutional barriers to successful implementation of these programs. Key performance indicators (KPI) are useful for determining the success of antimicrobial stewardship programs and for benchmarking purposes. To identify barriers to implementation of antimicrobial stewardship programs, the KPI used to measure program outcomes and the perceived usefulness of these KPI in Australian hospitals. Australian Directors of Pharmacy in private and public hospitals or their nominees (n=281) were surveyed by mail to identify barriers to, and the KPI used for antimicrobial stewardship programs at their hospitals. Hospital pharmacists, infectious diseases clinicians and infection control nurses were interviewed until saturation of themes was reached. Response rate for the postal survey was 29% (80 281). Main barriers to implementing antimicrobial stewardship programs encountered by respondents included: lack of education and training related to antimicrobial usage; prescribing culture at the hospital which was resistant to change; lack of resources to conduct stewardship activities; and lack of feedback to doctors, nurses and pharmacists on institutional antimicrobial use. Only 14 respondents used KPI to measure program outcomes. The KPI used between institutions were variable. Australian hospitals encounter many barriers to implementing antimicrobial stewardship programs. There are no standard national KPI to measure program outcomes. Most participants agreed that the KPI at their hospitals were useful.