Antimicrobial stewardship: an evidence-based, antimicrobial self-assessment toolkit (ASAT) for acute hospitals

Objectives To describe the methodology in developing an antimicrobial self-assessment toolkit (ASAT). Methods The ASAT was developed through a National Pharmacy Reference Group using an evidence-based approach of published information and national reports to identify criteria for inclusion. These were subdivided into domains that addressed: (1) Antimicrobial management within the Trust-structures and lines of responsibility and accountability-high-level notification to the Board. (2) Operational delivery of an antimicrobial strategy-operational standards of good antimicrobial stewardship. (3) Risk assessment for antimicrobial chemotherapy. (4) Clinical governance assurance. (5) Education and training-training needs and delivery of education and training for all who issue, prescribe and administer antimicrobials. (6) Antimicrobial pharmacist-systems in place for ensuring their optimum use. (7) Patients, Carers and the Public-information needs of patients, carers and the public. Results: A web-based toolkit was developed using information from national reports and guidance on antimicrobial stewardship. The toolkit offers a checklist for hospitals to self-assess their organizations' levels of antimicrobial stewardship. Conclusions: The ASAT offers a web-enabled, version-controlled instrument for the assessment of antimicrobial stewardship in acute hospitals. It may offer a sensitive instrument to assess longitudinal progress on antimicrobial stewardship in an individual institution or act as a benchmark with similar organizations. Further work is ongoing to evaluate and further refine the ASAT.