Framework for AS programs

Structure and governance

  • The overall accountability for antimicrobial management control lies with the hospital administration. They are responsible for ensuring an antimicrobial management program is developed and implemented, and outcomes are evaluated.
  • Hospital management support is needed, including:
  1. providing dedicated resources for stewardship activities, education, and measuring and monitoring antimicrobial use
  2. establishing a multidisciplinary AS team with core membership (wherever possible) of either an infectious diseases physician, clinical microbiologist or nominated clinician (lead doctor), and a clinical pharmacist
  3. ensuring that AS resides within the hospital’s quality improvement and patient safety governance structure, and clear lines of accountability exist between the chief executive; clinical governance; drug and therapeutics, and infection prevention and control committees; and the AS team.
  • Antimicrobial stewardship teams have clearly defined links with the drug and therapeutics committee, infection prevention and control committee, and clinical governance or patient safety and quality units.
  • Team members have clearly defined roles and responsibilities. Team members should be sufficiently supported and trained to enable them to effectively and measurably optimize antimicrobial use by using interventions appropriate to local needs, resources and infrastructure.
  • Antimicrobial stewardship process and outcome indicators should be measured and reported to the hospital executive.


Model for antimicrobial prescribing pathways in acute hospitals (Scotland). APP and P_Antimicrobial prescribing policy and practice. Source. Nathwani et al. JAC 2006;57:1189–1196

The AS team

  • Multidisciplinary teams are better suited to implement the kind of improvement and change required for effective AS. There are a range of professions and individuals that have an interest in and responsibility for AMS, each with different perspectives and skills.
  • Involving prescribers, pharmacists, administrators, infection control experts, information systems experts, microbiologists and ID physicians into a well-managed team effectively incorporates their views and expertise.
  • As a minimum, a multidisciplinary AS team or committee should include (core team members)
  1. an appropriate clinician (a microbiologist or ID physician, if available)
  2. and a clinical pharmacist (with ID training, if possible)


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