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