HOSPITAL ANTIBIOTIC POLICY: FROM PAPER TO ACTION:FILLING THE EXECUTION GAP

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HOSPITAL ANTIBIOTIC POLICY FROM PAPER TO
ACTIONFILLING THE EXECUTION GAP

• Dr. Anil GurtooProfessor,Deptt. of
  Medicine,Lady Hardinge Medical College,New
  Delhi.

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SITUATION ANALYSIS

• Although idealized Hospital Antibiotic Policies
  (HAP) do exist on paper, they rarely ever get
  executed at the point of care, leading to the
  emergence of an execution gap the disconnect
  between what-is-said and what-is-done.

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GAP-ANALYSIS

• So why dont the existing Antibiotic Policies
  work?
• Lack of clearly communicated goals.
• Lack of Leadership support.
• Top down approaches.
• Lack of participative approaches
• Poorly coordinated information systems.
• Lack of systems integration.
• Too clinician-centric approaches disconnected
  from other sectors.
• Silo-mentality and inter-departmental turf
  issues.
• Lack of antibiotic use susceptibility data.
• Supply side distortions.

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THE CHALLENGE

• To narrow and close the execution gap and create
  an Efficient and Effective HAP that really works
  on ground.

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THE VISION

• To create a culture of Rational Decision Making
  and Antibiotic use.

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THE MISSION

• To challenge and change the existing
  business-as-usual approach to Antibiotic Policy
  by creating an Effective and Adaptable Change
  Design.
•  

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DESIGNING A FRAME-WORK OF EXECUTION

• The 3 critical elements in the design pathway
• Development
• Dissemination
• Implementation

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DESIGNING A FRAME-WORK OF EXECUTION

• The Two Instruments of implementation
• Educational (Motivational)
• Regulatory (Restrictive Protocols)

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DESIGNING A FRAME-WORK OF EXECUTION

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SYSTEMS

• The workability or otherwise of HAP can be
  conceptualized as a function of the integrated
  working of 3 inter-dependent systems
• Administrative Governance System Comprising the
  decisional chain.
• Clinical Governance System comprising the
  implementing chain.
• Information Processing Systems.

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CULTURE

• BUSINESS AS USUAL
• Routinization of antibiotic use
• New is better
• Fever is synonymous with bacterial infection
• CULTURE SHIFT
• Antibiotics are non-renewable resources
• Multi-disciplinary team work
• Generic prescribing

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PROCESS

• Alignment between mission systems
• Synergies between systems
• Ethical Processes

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STRUCTURES

• The efficacy of HAP is a function of horizontal
  and vertical integration of 3 structures
• Administrative structure
• Financial structure
• Clinical structure

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HUMAN RESOURCE

• a. Training and b. Teamwork
• Training by way of regular CME s and workshops.
• Formation of Cross-functional Teams comprising
  of clinicians, pharmacologists, microbiologists,
  pharmacists, nurses and store officer.
• Communication Teams
• Antibiotic Therapeutic Teams
• Audit Teams
• Hospital Infection control teams.
• Clinical Rounds with Pharmacologist in
  attendance

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OUTCOME MEASURES

• CONTINUAL GOAL ASSESSMENT

AUDIT GOALS
Antibiotic Susceptibility Data
Antibiotic Prescribing Data
Costs ADRs
Pharmacy Stock Data
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