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

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

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

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”.

GAP-ANALYSISSo why don’t the existing Antibiotic Policies work?

a) Lack of clearly communicated goals.b) Lack of Leadership support.c) Top down approaches.d) Lack of participative approachese) Poorly coordinated information systems.f) Lack of systems integration.g) Too clinician-centric approaches disconnected from other

sectors.h) Silo-mentality and inter-departmental turf issues.i) Lack of antibiotic use – susceptibility data.j) Supply side distortions.

THE CHALLENGE

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

THE VISION

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

THE MISSION

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

DESIGNING A FRAME-WORK OF EXECUTION:

The 3 critical elements in the design pathway

• Development

• Dissemination

• Implementation

DESIGNING A FRAME-WORK OF EXECUTION:

The Two – Instruments of implementation

• Educational (Motivational)

• Regulatory (Restrictive Protocols)

DESIGNING A FRAME-WORK OF EXECUTION:

SYSTEMS

The workability or otherwise of HAP can be conceptualized as a function of the integrated working of 3 inter-dependent systems:

1.Administrative Governance System: Comprising the decisional chain.

2.Clinical Governance System: comprising the implementing chain.

3.Information Processing Systems.

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

PROCESS

• Alignment : between mission & systems

• Synergies : between systems

• Ethical Processes

STRUCTURES

The efficacy of HAP is a function of horizontal and vertical integration of 3 structures:

•Administrative structure

•Financial structure

•Clinical structure

HUMAN RESOURCE

a. Training and b. TeamworkTraining 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

OUTCOME MEASURES

CONTINUAL GOAL ASSESSMENTAUDIT GOALS

Antibiotic Susceptibility Data

Antibiotic Prescribing Data

Costs & ADRs Pharmacy Stock Data

Thank You