HOSPITAL ANTIBIOTIC POLICY: FROM PAPER TO ACTION:FILLING THE EXECUTION GAP Dr. Anil Gurtoo Professor, Deptt. of Medicine, Lady Hardinge Medical College, New Delhi.
Jan 01, 2016
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