Antimicrobial stewardship in regional, rural and remote hospitals: finding the X factor

Mrs Jaclyn Bishop1,2, Dr Thomas Schulz1,2,3, Dr David Kong1,2,4,5, Professor Karin Thursky1,2,3, Associate Professor Kirsty Buising1,2,3

1National Centre For Antimicrobial Stewardship (NCAS), Melbourne, Australia,

2University of Melbourne- Faculty of Medicine, Dentistry & Health Sciences (Department of Medicine- RMH), Melbourne, Australia,

3Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia,

4Monash University- Centre for Medicine Use and Safety, Parkville, Australia,

5Ballarat Health Services- Pharmacy Department, Ballarat, 3350


National Safety and Quality Health Service (NSQHS) accreditation mandates Antimicrobial Stewardship (AMS) programs in hospitals. Little is known about the contemporary barriers and enablers to successfully deliver AMS programs in Australian regional, rural and remote (‘regional’) hospitals.


Focus groups involving infectious diseases (ID) physicians, infection control practitioners, pharmacists and general practitioners with AMS experience in ‘regional’ Australian hospitals were conducted in 2017. The data was analysed qualitatively.


Participants described issues relating to AMS program delivery in ‘regional’ hospitals that aligned with these themes:

  • Resources; a lack of technology to assist with monitoring antimicrobial use, limited access to ID expertise, stretched pharmacy resources and multi-campus responsibilities.
  • Relationships; ‘small town relationships’ were described as both an enabler and a deterrent to providing feedback on antimicrobial prescribing.
  • Economy of scale; smaller numbers of patients made auditing easier. However, small size made justification of full-time AMS positions difficult, with staff often taking on multiple roles.
  • Translating data to action; some sites reported that audit data wasn’t being utilised for interventions due to a lack of expert guidance and governance.
  • Equity; concern resonated about the impact of inequitable AMS resources on patient care.

Accreditation was viewed as raising the profile of AMS, but not necessarily translating into greater resource allocation or practice changes.

AMS program success was more likely with good clinical governance and a stable workforce.


Facilitators for successful AMS programs were identified, however barriers to AMS in ‘regional’ hospitals persist despite mandatory accreditation.


Jaclyn has worked in a number of healthcare sectors as a pharmacist including acute health in regional settings, government, consultancy and education.

Jaclyn commenced her PhD with the National Centre for Antimicrobial Stewardship (NCAS) in 2016 and her research focuses on models for Antimicrobial Stewardship (AMS) programs in regional, rural and remote hospitals. By identifying key success factors for AMS programs in this setting, it is hoped that recommendations can be developed that will guide smaller hospitals towards AMS models that make the most of available resources.

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