'Reduce Resistance' An Antibiotic stewardship program to change prescribing practices in a Public Dental Service

This program implemented an antibiotic stewardship program (ASP) to change prescribing practices in one Public Dental Service with the aim of reducing the number of unnecessary antibiotic prescriptions and ensuring that those antibiotics which are prescribed adhere to best practice guidelines. There is vast scientific evidence that antibiotic resistance is promoted through excessive use of antibiotics and that Dental Surgeons are contributing significantly to this issue due to their inappropriate prescribing practices.

The HSE Change Model was used as a framework for the planning and implementation of this multifaceted Antibiotic Stewardship Program (ASP), which involved the implementation of best practice guidelines, clinical audit, an education program, an antibiotic ledger, and individualised clinician feedback. The ASP was designed considering the cultural, contextual and behavioural factors which influence prescribing practices. Staff engagement and effective communication was identified as critical for addressing resistance and ensuring a cycle of continuous improvement.

The evaluation found a measureable reduction in the numbers of antibiotics prescribed over the nine months of the program. Audit results provided evidence of adherence to best practice for antibiotic choice but, despite guideline implementation, discrepancies in the dosage and justification for prescription were found.

Ongoing stewardship interventions are required to sustain progress and encourage further improvements. Recommendations have been made for further research into the factors which influence the prescribing practice of dental surgeons.