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Determine the outcome and process measures that will be used to monitor the effectiveness
of the intervention. Outcomes of the interventions must be measurable. (Refer to section A.3)

Below is the example of AMS activities or interventions for improving antimicrobial prescribing
practice:

a) Antimicrobial treatment guideline and SAP guideline
Antimicrobial treatment guideline and SAP guideline can be adapted from the NAG
and endorsed at hospital level. These guidelines should be made accessible and
promoted to all healthcare professionals. Automatic stop orders might be applied
if the prescriptions do not adhere to these guidelines.

b) Antimicrobial Selection
Empirical antimicrobial selection is determined by the indication, suspected
causative organism and site of infection as per antimicrobial guidelines. A review of
a patient’s antimicrobial therapy after microbiology results are available is important
to avoid polypharmacy e.g. duplication of treatment, overlapping bacterial coverage
(e.g. metronidazole added on top of another antibiotic with anaerobic cover). Co-
administered medications should also be reviewed to prevent interactions with other
medicines.

c) Formulary Restriction and Pre-authorization
Formulary restriction is one of the pillars of AMS Programme. A list of restricted
antimicrobials shall be mentioned in the hospital antimicrobial policy (Appendix 6).

Restriction can be implemented in a number of ways:
• pre-approval (can only be started after getting a specific approval)
• temporary approval (can be started but would need approval for continued usage
and this can be done via antimicrobial order tools)

Methods to acquire approval:
• antimicrobial order tools
• telephone

d) Antimicrobial Order Tools
The order tools are designed to encourage the clinician to review basic clinical and
laboratory information and to categorize antimicrobial use as prophylactic, empirical
and therapeutic. An antimicrobial order tool may improve the quality of prescriptions
by increasing the awareness of clinicians of desired antimicrobial spectrum.

Second Edition 2022 | Protocol on Antimicrobial Stewardship (AMS) Programme in Healthcare Facilities 33