Antimicrobial Stewardship Program at a Tertiary Care Hospital A Road Less Travelled

The manuscript provides a practical overview of implementing an antimicrobial stewardship program from a very nascent stage to a well-established program in the complex setting of a tertiary care hospital. It gives the readers a road map to initiate or refine their journey utilizing many principles of quality improvement, common sense, and negotiating complex human behavior. It also showcases a good use of the scientific principles of quality improvement and change management. Starting small with well-defined surgical prophylaxis paved the way for the complex world of empirical prescription of antimicrobials later in this journey. Various strategies like prescription audit and feedback, handshake stewardship, antimicrobial time-out, and greater mindfulness towards antimicrobial prescription have been well highlighted. Regular point prevalence surveys provided us with actionable data for multiple interventions. Moreover, it highlights the well-defined process and outcome metrics that measured the various aspects of antimicrobial prescription and were instrumental in assessing the success or challenges in implementing the program. Compliance with surgical prophylaxis improved from 34 % to 71%, while compliance with de-escalation increased from 38% to 57%.