In daily clinical practice, prescribing antibiotics is a common and essential component of patient care. However, as treatment needs to be individualized, antibiotic prescribing is not always consistent or fully aligned with standard guidelines. For some patients, particularly those with complex comorbidities, antibiotic selection may not be fully appropriate based on organ function (e.g., renal or hepatic function), antibiotics may be used longer than necessary, or not adjusted in time according to changes in their condition. If not closely monitored, these limitations can reduce treatment effectiveness and increase the risk of antimicrobial resistance. This is why audit and feedback play an important role in helping clinicians review their prescribing practices and ensure that antibiotics are used appropriately and safely.
Within the 60HN ASPARNet activities, audit and feedback are applied as a key component to support hospitals in improving antibiotic use. Its main activities include developing an action plan, establishing a dedicated audit and feedback team, and implementing audit and feedback in a consistent manner to enhance the quality of patient care. Network hospitals were provided with technical support from technical experts from Hanoi University of Pharmacy, National Hospital for Tropical Diseases, Saint Paul General Hospital, and standard operating procedures, guidance on implementation for both therapeutic antibiotic use and surgical antibiotic prophylaxis.
At the hospital, an Antimicrobial Stewardship (AMS) team for audit and feedback is established, typically consisting of two to three members who may be clinical doctors or clinical pharmacists involved in treatment and patient support, particularly those experienced in infectious diseases and rational antibiotic use. In larger hospitals, a microbiologist may also be included to provide more in‑depth analysis.
AMS team is responsible for carrying out audit and feedback activities, summarizing findings, and reporting regularly to the hospital’s AMS Committee on a regular basis or by specific topics. They are considered the “core team” who play a central role in monitoring and evaluation to generate evidence that informs the AMS committee’s policy decisions and supports improvements in clinical practice, ensuring that treatment protocols are appropriately implemented, thereby enhancing the quality of care and strengthening patient safety within the hospital.
To implement audit and feedback, AMS team develops a detailed plan outlining the audit focus, methodology, scope, frequency, personnel, and timeline, along with the responsibilities of each member. Once approved, the plan is shared with relevant departments for coordination.
During the audit, AMS team reviews the antibiotic prescriptions in each patient’s medical record and compares them with the hospital’s treatment guidelines and national standards issued by the Ministry of Health. When clarification is needed, they may discuss directly with the prescribing clinicians, nurses, or even the patients. All collected information is documented carefully using the corresponding audit forms.
Audit activities can be carried out in two forms: prospective audit (reviewing patients currently receiving inpatient treatment) and retrospective audit (reviewing records of patients who have been discharged). Both forms provide AMS committee with a comprehensive view of prescribing practices and help ensure timely adjustments when necessary.
After completing the audit and compiling the findings, AMS team provides feedback directly to the prescribing clinicians. In prospective audits, feedback is delivered on the same day to help clinicians promptly adjust treatment and improve outcomes for current patients. Feedback may be given through direct discussion, notes in the medical record, reports to the department, or presentations in meetings.
For retrospective audits, AMS team summarizes the results and shares them with prescribing clinicians or clinical departments. Although conducted after patient discharge, retrospective feedback remains valuable in improving prescribing practices for similar cases in the future.Thanks to audit and feedback, antibiotic use in hospitals becomes more appropriate and consistent. Patients receive the right drug, at the right dose, at the right time, reducing unnecessary antibiotic use, minimizing adverse events, and improving treatment outcomes. Rational antibiotic use also plays an important role in reducing antimicrobial resistance—an increasingly pressing challenge in healthcare settings today. At the same time, clinicians and pharmacists have more opportunities to exchange expertise, strengthen knowledge, and refine their prescribing practices. For hospitals, this activity helps them better understand antibiotic use across their system, identify common issues early, and develop targeted solutions to improve treatment quality in the long term.
