SWOT analysis of current status of key components, assessment of needs and interventions implemented at two provincial hospitals
| Component | SWOT analysis (strength–weakness–opportunity–threat) | Assessment of needs | Interventions implemented |
| Hospital 1 | |||
| Leadership | S: leadership commitment; vice-director had an active role in AMS committee W: no AMS experience, large committee with no dedicated AMS coordinator for day-to-day activities O: guidelines from MoH and experience from other higher level hospitals; leadership intention to provide AMS outreach support to district hospitals in long term T: disease outbreaks (eg, COVID-19) shifting management priorities | Knowledge and skills in planning and implementing AMS Identify clear roles in planning and implementing AMS activities Identify targets for interventions | Establishing AMS action team for day-to-day activities with active coordination from Planning Department Regular minuted team meetings Training for AMS committee by international and local experts Collecting and reviewing data to inform interventions |
| Pharmacy | S: drug inventories and bidding W: no clinical experience; only tracking drug purchasing but not actual drug use data; lack of analytical skills O: electronic data on patient-level drug administration available from clinical database; government policy and guidelines (clinical pharmacy, AMS guidelines) T: high staff turnover, lack of clinical pharmacists, bidding process and insurance limits (can affect drug choices and prescribing behaviours) | Identify staff for clinical pharmacist roles Build clinical pharmacy capacity and data analysis skills | Training for clinical pharmacists in antibiotic treatment, microbiology, pharmacology and review of antibiotic prescriptions (class-room, hands-on) Implemented prospective audit and feedback as a routine activity of clinical pharmacy programme Participation of clinical pharmacists in clinical ward monthly meeting for which they had to analyse audit data and present to the doctors Support from DASON on using web-based data visualisation and benchmarking tool* |
| Microbiology | S: in-house microbiology laboratory; technical support by OUCRU; use WHONET database W: contamination issues, low test utilisation; lack of clinical interactions; no clinical microbiologist; performing manual culture; limited quality control O: close connection with OUCRU laboratory; a new laboratory under construction T: lack of compliance in sample collection from clinical wards; weak voice in planning and ordering reagents and tests; insurance limits (can affect culture ordering behaviour) | Improve quantity and quality of routine clinical specimens, and quality of microbiology testing Active planning from microbiology laboratory Active communication from laboratory to clinical wards on patient’s specimens and test results More regular tailored updates on local AMR data to support doctors in empiric treatment | Training on clinical microbiology for laboratory staff by locally recognised experts Review/update Standard Operating Procedures (SOPs) with support from OUCRU laboratory Nurse training on collecting clinical specimens Support from OUCRU laboratory to review the current microbiology practices and planning for improvement Analysis of WHONET data twice yearly and creating readable summary of AMR patterns to doctors |
| Infection management | S: hospital-wide consultations with ID doctor available; head of ID department is in the AMS committee W: limited access to training O: established connection with Hospital for Tropical Diseases in Ho Chi Minh City T: disease outbreaks (eg, COVID-19) | Update knowledge and skills in management of specific and locally relevant infectious diseases, clinical pharmacology and antibiotic treatment guidelines | Training on infectious diseases management and antibiotic treatment for main clinical syndromes, principals of clinical pharmacology and microbiology and surgical prophylaxis |
| Hospital 2 | |||
| Leadership | S: leadership commitment W: no AMS experience, large committee with no dedicated AMS coordinator for day-to-day activities O: MoH guidelines and experience from other higher-level hospitals; leadership dedication to high-quality hospital performance T: disease outbreaks (eg, COVID-19) shifting management priorities; hospital’s focus on surgical services and cancer treatment | Knowledge and skills in planning and implementing AMS Identify clear roles in planning and implementing AMS activities Raise the awareness and stimulate interests of surgical doctors in AMS Identify targets for interventions | Establishing AMS action team for day-to-day activities with active coordination from Planning Department and International Relations Department Select four surgical wards to participate in the study (two intervention and two control wards) Training for AMS team by international and local experts Collecting and reviewing data to inform interventions |
| Pharmacy | S: drug inventories and bidding; young pharmacists available; hospital has interest in improving clinical pharmacy programme W: limited clinical experience; only tracking drug purchasing but not actual drug use data; lack of analytical skills O: electronic data on patient-level drug administration available from clinical database; government policy and guidelines (clinical pharmacy, AMS guidelines); close connection with the Hanoi University of Pharmacy for clinical pharmacy training T: non-compliance from surgical departments; bidding process and insurance limits (can affect drug choices and prescribing behaviours) | Identify staff for clinical pharmacist roles Build clinical pharmacy capacity and data analysis skills | Training for clinical pharmacists in antibiotic treatment, microbiology, pharmacology and review of antibiotic prescriptions (class-room, hands-on) Implemented prospective audit and feedback as a routine activity of clinical pharmacy programme Participation of clinical pharmacists in clinical ward monthly meeting for which they had to analyse audit data and present to the doctors Join doctors in their clinical ward rounds to get more clinical experience and interactions with doctors Support from DASON on using web-based data visualisation and benchmarking tool* |
| Microbiology | S: in-house good-quality microbiology laboratory; technical support by OUCRU and US CDC; use WHONET database W: limited clinical interactions O: close connection with OUCRU laboratory; have access to advanced techniques and skills T: lack of compliance in sample collection from some clinical wards | Increase communication with doctors on patient’s specimens and test results Increase clinical experience for clinical microbiologists More regular tailored updates on AMR data to support doctors in empiric treatment | Experience sharing and discussions for lab staff with locally recognised experts Analysis of WHONET data twice yearly and creating readable summary of AMR patterns to doctors Join doctors in their clinical ward rounds to get more experience and interactions with doctors |
| Infection management | S: hospital-wide consultations with ID doctor and specific specialists available; strong experience from ICU doctors in difficult cases W: no presence of ID doctor in AMS committee O: established connection with national-level hospitals T: disease outbreaks (eg, COVID-19); dominance of surgical and ICU doctors in determining antibiotic choices for patients | Update knowledge and skills in management of specific and locally relevant infectious diseases, clinical pharmacology and antibiotic treatment guidelines Increase the interests and awareness of surgical doctors in AMS | Training on infectious diseases management and antibiotic treatment for main clinical syndromes, principals of clinical pharmacology and microbiology and surgical prophylaxis for young doctors Set the target for reducing use of two or more antibiotics for surgical prophylaxis in traumatology department |
*Delayed due to discussions on data sending outside of Vietnam and where the tool could be located.
AMR, antimicrobial resistance; AMS, antimicrobial stewardship; DASON, Duke Antimicrobial Stewardship Outreach Network; ICU, intensive care units; ID, infectious diseases; MoH, Ministry of Health; OUCRU, Oxford University Clinical Research Unit.