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Wrong dose interval Antibiotics are prescribed with the wrong dose interval (too
much time between doses).

Wrong route Antibiotics are prescribed by the wrong route (e.g. IV instead
of oral).

Wrong duration Duration of antibiotic treatment is not at optimized period
(e.g. antibiotics prescribed for too long a period, prolonged
surgical prophylaxis).

Delayed Administration of the antibiotic(s) is delayed from the time of
administration prescription. Repeat doses are not administered in a timely
way, which is critical in the case of septic shock and other
serious infections.

Example of Surgical Antibiotic Prophylaxis Forms & Work Process (Appendix 5).
Example of Surgical Antibiotic Prophylaxis Audit Data Collection Protocol – Google Drive
link: https://drive.google.com/drive/folders/1rRhsRQKW8XHNATDKrispuxekWwCUaLo9?usp=sharing

Step 2 - Develop and implement targeted AMS interventions based on the
identified areas of concern in Step 1

After areas of intervention has been identified through audits (i.e. specific location, e.g. ward
or unit or disease condition or antibiotic with high usage), the AMS team should discuss on
the interventions that can be applied. If the intervention involves a unit/discipline, the AMS
team should meet up with the respective unit/discipline, select a champion from the
unit/discipline that can give commitment to make changes, set goals of what to achieve in
changing the antimicrobial practice and discuss on possible strategies and interventions that
can be implemented tailored to the local settings.

AMS interventions should be implemented in a stepwise approach. Start with strategies that
are simple and doable, building on the existing structures, maximizing teamwork and
encouraging champions among clinical staff including prescribers in developing the
intervention. AMS interventions should align with local needs.

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