Purpose

This framework describes best practice in using IT systems in the management of antimicrobial stewardship (AMS). It is relevant to digital and clinical leadership teams and commissioners in all healthcare settings.

Specifically, this framework outlines the actions needed to meet the following 7 success measures:

• well led
• smart foundations
• safe practice
• support people
• empower patients
• improve care
• health populations

It supplements the digital vision for antimicrobial stewardship which provides developers and healthcare IT professionals with guidance for creating or updating clinical digital systems.

Success measure 1: Well led

What good looks like

Stewardship teams own and drive antimicrobial stewardship digital transformation and are supported to do so by digital and clinical leaders.

Your organisation should:

• create a digital antimicrobial stewardship strategy, ensuring it has input from clinical representatives across the organisation
• build digital and data expertise within antimicrobial stewardship and ensure that stewardship is appropriately prioritised and resourced within the organisation’s digital strategy
• create clear accountability for digital transformation of antimicrobial stewardship within the antimicrobial resistance (AMR) governance process
• establish governance processes that regularly review digital antimicrobial stewardship interventions and data to ensure that interventions are improving quality of care.
• identify digital and data solutions to improve care by regularly engaging with frontline users and the public.
• invest in multidisciplinary expertise to support digital antimicrobial stewardship and ensure clinical informatics leads have the appropriate skills, time and authority to direct change and adopt best practice
• build effective partnerships with the providers of digital technologies used to optimise prevention and management of infection, to ensure that systems are fit for purpose in supporting antimicrobial stewardship

Success measure 2: Ensure smart foundations

What good looks like

IT infrastructure and data are used effectively to support antimicrobial stewardship. Organisations have well-resourced teams who can deliver modern, safe and effective digital antimicrobial stewardship solutions.

Your organisation should:

• build well-resourced multidisciplinary teams with the clinical, operational, informatics, design and technical expertise to deliver your digital antimicrobial stewardship ambitions
• review staffing levels to ensure there is appropriate capacity to support antimicrobial stewardship in digital systems and reflect this in workforce planning and job descriptions.
• consider the potential impacts of digital innovation on workforce capacity and working lives
• ensure software and processes are sufficiently agile for timely response to issues that can affect practice, for example, MHRA alerts, drug shortages or infection outbreaks
• ensure hardware and IT infrastructure are reliable and secure, and meet the requirements of the software packages used, for seamless performance

Success measure 3: Safe practice

What good looks like

Organisations maintain safe and continuously improving practice in prevention and management of infections through the optimal use of clinical digital systems. They routinely review digital antimicrobial stewardship solutions to ensure they are safe and effective in improving care and outcomes.

Your organisation should:

• reduce harm to patients from medication errors, healthcare-associated infection and suboptimal infection management through optimal use of clinical digital systems, surveillance data and clinical audit
• use real time data for quality improvement work
• optimise the use of alerts and decision support to improve care while avoiding safety and capacity issues associated with disruptions to workflow and interruptive alerts

Success measure 4: Support people

What good looks like

Organisations have a digitally literate workforce which can use data and technology to support antimicrobial stewardship. Digital and data tools and systems are fit for purpose and support staff to do their jobs well.

Your organisation should:

• support AMS staff to attain an appropriate level of data, digital and cyber security literacy
• integrate the clinical informatics workforce into the antimicrobial stewardship team and ensure digital clinical informatics specialists are represented on the antimicrobial stewardship committee
• ensure digital antimicrobial stewardship interventions improve the quality of care, including by automating processes where possible to release time for patient care, and the working lives of staff, without unintended consequences
• ensure that the systems your staff use are intuitive, easy to use and display all the key clinical information they need to optimise patient care, avoiding the need to refer to multiple digital systems to access information
• embed tools and support in digital systems to guide prescribing decisions and identify risk of deterioration
• integrate diagnostics (sampling and results) into clinical workflows
• ensure antimicrobial stewardship prompts and alerts are consistent with the 5 rights of digital alerts (right information, right person, right format, right channel, right time)
• improve interoperability between digital systems for the seamless transfer of key information between care providers, including laboratory results, antimicrobial therapy, allergies and treatment plans
• enable data driven improvement by prioritising automated data collection, simplifying data extraction processes, and making data widely available and easy to use, for example, through dashboards that provide context and insight
• consider the development and integration of artificial intelligence, predictive analytics and risk or severity score calculators to support antimicrobial stewardship

Success measure 5: Empower patients and the public

What good looks like

The needs of patients are at the centre of service design and they have access to a standard set of digital services that cater for all levels of literacy and digital inclusion. Patients can access and contribute to their healthcare information, taking an active role in their health and wellbeing.

Your organisation should:

• use digital communication tools to enable appropriate self-care, service access, condition management, advice and guidance
• use digital tools to empower shared decision-making in infection prevention and control (IPC) and promote appropriate self-care
• promote the use of patient-held digital care records of significant infection information, such as previous antibiotics treatment, vaccination status, colonisation with key pathogens, medication allergies, Clostridioides difficile infection (CDI) history or risk, previous infection with resistant organisms

Success measure 6: Improve care

What good looks like

Health and care practitioners (HCP) embed digital and data in their improvement capability to transform care pathways, reduce unwarranted variation and improve antimicrobial stewardship. Digital solutions enhance services for patients and ensure that they get the right care, at the right time and in the right place.

Your organisation should:

• train the workforce to optimise use of digital antimicrobial stewardship technologies
• promote the use of digital tools and technologies that support antimicrobial stewardship
• assess the impact of implemented digital tools and solutions on patient outcomes, stewardship metrics and antimicrobial resistance
• provide decision support and other tools to help clinicians follow best practice and eliminate unwarranted variation across the care pathway
• use digital systems to capture antimicrobial stewardship metrics and performance
• support data-driven improvement through better design and use of digital technologies

Success measure 7: Healthy populations

What good looks like

Organisations use data to inform their care planning and support the development and adoption of innovative integrated care system (ICS)-led, population-based, optimised infection prevention and control strategies.

Your organisation should:

• use data to inform patient management pathways, guidelines and prevention strategies, for example, antibiograms to create clinical guidelines
• use insights from data to reduce health inequalities associated with infection and antimicrobial resistance, and unwarranted variation in care
• share your organisation’s data to build evidence and support the development of antimicrobial stewardship tools
• drive digital antimicrobial stewardship innovation through collaboration with academia, industry and other partners

Publication reference: PRN01399ii