Improving Antibiotic Stewardship Across Queensland Hospitals

Antibiotics save lives, yet unnecessary or poorly targeted use can accelerate antimicrobial resistance, increase adverse drug reactions and prolong hospital stays. Queensland hospitals manage a broad mix of metropolitan, regional and remote patients, making responsible prescribing a clinical priority as well as a health-system responsibility.

A multi-site audit and feedback study can show where antibiotic decisions differ between wards, hospitals and specialties. By combining prescribing data with practical feedback for clinicians, the approach supports safer treatment, better documentation and consistent care across settings from Brisbane to Cairns, Toowoomba and regional Queensland.

Why stewardship matters in Queensland

Antibiotic stewardship means choosing the right medicine, dose, route and duration for a confirmed or suspected infection, then reviewing that decision as new information becomes available. It includes timely cultures, accurate allergy histories, treatment de-escalation and a clear stop or review date. These actions help preserve antibiotic effectiveness while protecting individual patients.

Queensland’s health system includes large tertiary hospitals, private facilities, smaller regional services and rural hospitals with different staffing models and laboratory access. A prescribing practice that is feasible at the Royal Brisbane and Women’s Hospital may need adjustment in a remote service where infectious diseases advice, microbiology support or after-hours pharmacy coverage is limited.

Local prescribing is also shaped by Australia’s regulatory environment. Hospital medicines must be managed under Queensland’s Medicines and Poisons Act 2019, while the National Safety and Quality Health Service Standards set expectations for medication safety and antimicrobial stewardship. The Pharmaceutical Benefits Scheme influences community prescribing after discharge, although inpatient supply and hospital formularies follow separate procurement and governance processes.

Building a useful multi-site audit

The study should begin with a shared audit protocol that defines the patient groups, antibiotics, clinical indications and measures being assessed. Suitable samples might include pneumonia, urinary tract infection, bloodstream infection, surgical prophylaxis and sepsis. Auditors can review medication charts, electronic prescribing records, pathology results and discharge summaries against local guidelines.

Core measures could include guideline concordance, allergy documentation, culture collection before treatment where clinically appropriate, intravenous-to-oral conversion, duration accuracy and review within 48 to 72 hours. Patient factors such as renal function, age, pregnancy, immune status and allergy history should be recorded because a simple percentage may hide legitimate clinical variation.

Consistency matters when several hospitals participate. Auditors need training, a shared data dictionary and a process for resolving uncertain cases. Data should be de-identified before analysis, with results reported in a way that supports learning rather than individual blame. Comparing sites by specialty and case mix is more informative than publishing an unqualified league table.

Making feedback change prescribing

Audit data has value only when clinicians receive it promptly and can act on it. A useful feedback cycle combines a short report with ward-level discussion, examples from real cases and one or two specific actions. For instance, a surgical team might focus on stopping prophylactic antibiotics within the recommended period, while a medical ward might prioritise documented indication and review dates.

Feedback is more persuasive when it is delivered by respected local peers, supported by pharmacists, microbiologists, nurses and infection prevention staff. Messages should recognise clinical pressures, including emergency presentations, bed movement and the need to start treatment before a diagnosis is certain. The aim is to improve decisions at the next review, not to criticise treatment chosen during a deteriorating patient’s first hour.

Digital prompts can reinforce the process. Electronic medical records may require an indication, display local guidelines or flag prolonged intravenous therapy. However, technology should complement clinical judgement. In hospitals with limited digital integration, paper review stickers, pharmacist rounds and brief team huddles can provide an effective alternative.

Connecting research, governance and implementation

A multi-site study needs early agreement about data access, authorship, privacy, reporting and responsibility for action. Researchers, Queensland Health services, universities and consumers can define the questions together so the project produces findings that are credible and useful in practice. The Brisbane Diamantina network’s guidance on partnering with industry is also relevant when a study involves software, decision-support tools or other commercial products.

Ethics and governance review should match the project’s design. A quality improvement activity using routinely collected, de-identified data may follow a different pathway from a research study that links prescribing records with patient outcomes. Where several services participate, coordinated review can reduce duplication while preserving each organisation’s accountability. Researchers can draw on advice about multi-site clinical trials when planning approvals, site authorisation and information management.

Consumer and community perspectives also have a practical role. Patients may be concerned about side effects, resistant infections or why an antibiotic is stopped when they still feel unwell. Clear discharge instructions, interpreter access and culturally safe communication can improve understanding, particularly for Aboriginal and Torres Strait Islander communities and families travelling long distances for care.

Measuring outcomes and sustaining gains

The strongest evaluation combines process, clinical and balancing measures. Prescribing appropriateness may improve while readmissions, mortality, length of stay or treatment escalation remain unchanged. Those outcomes should be monitored rather than assumed. It is equally important to check for unintended effects, such as delayed treatment in sepsis, increased use of broad-spectrum alternatives or workload that undermines adoption.

A follow-up audit at three, six and twelve months can show whether change persists after the initial feedback. Results should be shared with hospital executives, antimicrobial stewardship committees, prescribers and frontline teams. Recognition of improvement can help maintain momentum, while recurring gaps may indicate a need for guideline revision, education or better access to diagnostics.

Practical priorities for participating hospitals

• Agree on a small set of common measures before collecting data.
• Include metropolitan, regional and rural sites to reflect Queensland’s health system.
• Provide feedback within weeks, while clinical examples remain recognisable.
• Pair prescribing data with patient safety, resistance and workload measures.
• Involve pharmacists, prescribers, nurses, microbiologists, consumers and Aboriginal health representatives.
• Repeat audits after implementation to test whether improvements are sustained.

A coordinated audit and feedback study can turn antibiotic stewardship from a policy requirement into a routine clinical habit. Queensland hospitals can use shared evidence, local expertise and respectful feedback to improve treatment today while preserving effective antibiotics for patients and communities in the future. Multidisciplinary teams, research partners and health services can begin by agreeing on a common audit question, establishing governance and testing one practical change in the next prescribing cycle.