Development of a Dashboard for the Antimicrobial Stewardship Program in a Hospital: A Case Study of Angthong Hospital

Abstract

Objective: To develop a dashboard to support antimicrobial stewardship activities at Ang Thong Hospital. Methods: Relevant indicators for monitoring appropriate antimicrobial use were identified from three main sources: 1) antimicrobial stewardship programmes in health-care facilities in low- and middle-income countries: a WHO practical toolkit; 2) indicators of Ministry of Public Health for antimicrobial resistance management; and (3) in-depth interviews with five pharmacists responsible for antimicrobial stewardship at Ang Thong Hospital.  The interview also explored their perspectives and requirements for dashboard development. The essential indicators and required data elements to be shown on the dashboard were then consolidated. Data were retrieved from the hospital information system, and additional data collection tools were developed for information not available in the system. All data were stored in Google Sheets and subsequently used to develop the dashboard using Looker Studio. The developed dashboard was then evaluated for functional performance by three expert pharmacists on the following areas--infectious diseases and antimicrobial use, general informatics, and hospital informatics. Subsequently, the dashboard was pilot-tested by five pharmacists responsible for antimicrobial stewardship at Ang Thong Hospital over a three-month period, during which user satisfaction with the system was also assessed. Results: Ten key indicator domains were identified as necessary for dashboard display: 1) overall antimicrobial stewardship performance summary; 2) appropriateness assessment at first review (within 7 days); 3) appropriateness assessment at second review (after 7 days); 4) DDD per 1,000 patient-days; 5) annual antimicrobial consumption volume; 6) annual antimicrobial expenditure; 7) incidence of Clostridium difficile infection; 8) multidrug-resistant infections according to the Ministry of Public Health AMR service plan; 9) 30-day readmission rate due to infections; and 10) in-hospital mortality related to infections. User satisfaction (mean ± SD, on a 5-point scale) was reported as follows: dashboard content 3.93±0.80, data accuracy 4.30±0.35, dashboard design 4.10±0.74, ease of use 3.80±0.84, and timeliness of data updates 4.00±0.71, with an overall satisfaction score of 4.00±0.71. Conclusion: The developed dashboard demonstrated high levels of satisfaction among pharmacist users in terms of content, data accuracy, visual design, usability, and update frequency. The dashboard has potential to support decision-making in antimicrobial stewardship programs