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Table 3 Mapping of emergent themes and sub-themes addressed within ASAT v16 and the proposed draft domain

From: Perspectives of clinical microbiologists on antimicrobial stewardship programmes within NHS trusts in England

Themes Sub-themes ASAT v16 Proposed domain
National prioritisation and initiatives for reducing hospital-acquired infections Hospital-based initiatives
 • Promotion and implementation of ASPs
Section 1: Q1.1 to Q1.3 -
NHS trust board and senior management leadership Section 1: Q1.1 to Q1.4 -
Collaboration with other hospital-based initiatives such as infection prevention and control programmes e.g., reduction of HAIs Section 1: Q1.1 to Q1.3 -
Antimicrobial stewardship committee Senior management membership with decision-making capacity within NHS trusts Section 1: Q1.4 Draft question 1
MDT committee membership including nurses and specialist pharmacists - -
Clinical leadership of antimicrobial stewardship committees - Draft question 1
Antimicrobial policies and guidelines Development procedures
 • MDT involvement throughout entire process
- Draft question 2
Draft question 4
Update procedures
 • Incorporation of resistance trends
 • Effective communication of updates to antimicrobial prescribers
Section 2: Q2.6, Q2.15, Q2.21 Draft question 3
Draft question 7
Section 2: Q2.11, Q2.17
Accessibility issues Section 2: Q2.9, Q2.10 -
Non-standardised regional and international guidelines - -
Role of hospital-based pharmacists Antimicrobial pharmacists Section 6: Q6.1 to Q6.9 -
Ward pharmacists - -
Other specialist pharmacists - -
Non-medical prescribers
 • Increased remit in antimicrobial prescribing
Section 5: Q5.4, Q5.5, Q5.13, Q5.18 -
Current antimicrobial prescribing practices Empirical prescribing practices
 • Need for rapid diagnostics
  -
Autonomous prescribing practices by senior clinicians and surgeons Section 5: Q5.4, Q5.5, Q5.12 -
E-prescribing
 • Availability and accessibility of ‘real-time’ data
 • Antimicrobial consumption data e.g., DDDs
 • Communicating rationale for prescribing decisions
Section 4: Q4.8 to Q4.9 Draft question 6
Clinical audit programmes Types of audits e.g., point prevalence, alert audits Section 4: Q4.1 to Q4.7 -
Clinical leadership of antimicrobial-related audits - -
Feedback mechanisms to relevant stakeholders e.g., NHS trust boards and antimicrobial prescribers Section 1: Q1.8 -
Section 3: Q3.5
Section 4: Q4.9 to Q4.12
Need for frequent antimicrobial prophylaxis guideline audits Section 4: Q4.5 -
Prescribers’ knowledge about antimicrobial chemotherapy Modes of education e.g., formal vs. informal modes Section 2: Q2.22, Section 5: Q5.1 to Q5.15 Draft question 5
Knowledge gaps of junior prescribers Section 5: Q5.1 to Q5.15 -
Workload implications e.g., out-of-hours requests Section 2: Q2.23 -
Deskilling antimicrobial prescribers e.g., lack of ownership of prescribing decisions Section 5: Q5.1 to Q5.15 -
IT infrastructure E-prescribing systems Section 4: Q4.1 to Q4.9 -
E-auditing systems Section 4: Q4.1 to Q4.9 -
Need for improved IT infrastructure within clinical microbiology laboratories e.g., antimicrobial susceptibility testing Section 2: Q2.11, Q2.17 Draft question 6
Financial resource allocation Time dedicated to antimicrobial-related duties Section 6: Q6.3 -
Specialist staff to bed ratio required for effective antimicrobial stewardship - -
  1. ASPs Antimicrobial stewardship programmes, HAIs Hospital-acquired infections, MDT Multidisciplinary team, NHS National Health Service, DDDs defined daily doses, IT information technology