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Step 1 - Identify areas for improvement based on available data

1.1 Surveillance data

Surveillance of antimicrobial use can show us how and why antimicrobials are being used by
healthcare providers. Situation analysis via monitoring of antimicrobial prescription and
consumption with comparison to national data provides insights and helps determine the area
(ward/service/discipline) or antibiotic to be targeted for intervention. Access to information on
antimicrobial consumption is an important source for healthcare professionals and policy
makers and is the first step in increasing awareness of the importance of careful antibiotic use.
Routine measurement and display of consumption information to healthcare professionals and
policy makers can help monitor progress in our effort towards a more prudent use of
antimicrobials. Prescribers should be made aware of their own prescribing practices. Thus,
feedback to prescribers is one potential form of intervention.

Collection and analysis of local antimicrobial consumption
• Data collection and analysis of antimicrobial use should be done periodically (at
least three monthly). The report of antimicrobial use should be disseminated to
clinician and discuss the results in relevant meeting.

Indicators for reporting antimicrobial consumption
• Daily Defined Dose (DDD) per 1000 Patient Days is used to determine the
antimicrobial utilisation in adult patients.
• Days of Therapy (DOT) per 1000 Patients days is used to determine the antimicrobial
utilisation in paediatric patients.
• ABC VEN analysis is used to justify the selection of antibiotic in a facility.
• Identify marked increase in antimicrobial utilisation.

Provision of data to regional /national surveillance programmes
• The data should be reported and presented at local and state levels. It also has to be
submitted to Pharmacy Practice and Development Division, MOH for National
Surveillance on Antibiotic Utilisation (NSAU).
• Comparisons between similar services in different institutions with similar capacity
and case-mix may yield useful information.
• Identify hospital/ICU with high usage of antimicrobial at the state or national level.

Second Edition 2022 | Protocol on Antimicrobial Stewardship (AMS) Programme in Healthcare Facilities 29