The Univeristy of Melbourne The Royal Melbourne Hopspital

A joint venture between The University of Melbourne and The Royal Melbourne Hospital


13 Feb 2024

NAPS, celebrating a decade of antimicrobial stewardship

The National Antimicrobial Prescribing Survey (NAPS) recently celebrated ten years of spearheading antimicrobial stewardship (AMS). AMS is a comprehensive and strategic approach to managing the use of antimicrobial drugs in an effort to improve patient safety and outcomes while addressing the growing global health issue of antimicrobial resistance (AMR).

Homegrown from the Royal Melbourne Hospital, NAPS originated in response to a gap and identified need in clinical support. It was created to assist healthcare facilities with assessing the quality of antimicrobial prescribing. The initiative is coordinated by the Royal Melbourne Hospital Guidance Group and the National Centre for Antimicrobial Stewardship (NCAS, University of Melbourne), who seek to optimise antimicrobial use in both human and animal health, using a One Health approach.

The Royal Melbourne Hospital’s Professor Karin Thursky, Director of the National Centre for Antimicrobial Stewardship (NCAS) and the Royal Melbourne Hospital Guidance Group at the Doherty Institute, said that like most successful innovations, the tool was designed to address an unmet clinical need.

“When AMS was introduced in the accreditation standards, it meant that all Australian hospitals were required to implement AMS despite a small workforce and limited knowledge. NCAS and the RMH Guidance Group saw the urgent need to provide a standardised auditing tool to capture the quality of antimicrobial prescribing. This is when NAPS was created,” she explained.

Since its inception a decade ago, NAPS has undergone significant growth and evolution. The number of health facilities using the platform has seen a remarkable seven-fold increase, accompanied by the integration of expanded clinical modules and a substantial rise in participating users. From a presence in 130 hospitals in 2013, NAPS is now rolled out in 700 participating facilities, engaging 7,000 users across 13 countries. The program has evolved into a comprehensive suite of clinical AMS tools tailored to meet the diverse needs of hospitals, aged care homes, surgery and specialist cancer centres.

Over time the team behind NAPS worked with various collaborators, including the Australian Commission on Safety and Quality in Health Care (ACSQHC), the National Centre for Infections in Cancer (NCIC), the Peter MacCallum Cancer Centre (PMCC) and the National Antimicrobial Allergy Network (NAAN). Notably, the Victorian Healthcare-Associated Infection Surveillance System (VICNISS) helped bring the initial vision of a standardised auditing platform to life, and has since continued to provide expert advice and epidemiological support for the Aged Care NAPS program.

The Royal Melbourne Hospital’s Dr Rod James, Clinical Director of the RMH Guidance Group, AMR theme co-lead at the Doherty Institute, and one of the early founders of the NAPS program said that, since the beginning, the aim has been to streamline the process for the end users.

“The team’s focus is on building an audit with immediate and relevant data visualisation. This means users would no longer have to manually interpret and generate their reports,” he said.  

“We also built the functionality to directly compare an individual facility’s results against those of other participating facilities in a de-identified manner. This ensures a confidential and insightful benchmarking process, allowing facilities to assess their performance relative to peers within the program without compromising privacy.”

During this period, NAPS has demonstrated transferability across diverse clinical settings and countries with vastly varying levels of AMS readiness, but also revolutionised the AMS landscape in Australia. 

NAPS is now embedded in Australia’s National AMR Strategy, influencing hospital and aged care accreditation guidelines and a national AMS clinical care standard. It is also a critical component of the Antimicrobial Usage and Resistance in Australia (AURA) surveillance program and receives funding from the Australian Government Department of Health and Aged Care.

Ms Christina Bareja, Director of AMR Policy at the Australian Government Department of Health and Aged Care, said NAPS embodies all the qualities of an effective surveillance and stewardship system.

“It puts data and insights into the hands of people who can really make a difference and it’s truly data driving action,” she said.

Today, the NAPS is a testament to the successful collaboration between technical and clinical expertise. As a digital health platform, NAPS now sits at an interesting and exciting juncture in the more general use of technology in healthcare. 

“We are currently redesigning and rebuilding the NAPS application to set a strong foundation and ensure we meet future scalability and continued expansion of the program,” said Ms Caroline Chen, Senior AMS Pharmacist and NAPS Re-Design Project Lead at the RMH Guidance Group.

“In particular, we are considering the more mature needs of users, simplifying the audit process to optimise the time end-user clinicians can spend actually engaging with prescribers and other clinicians.

“We are focusing more on data visualisation and intelligent reporting, as well as better supporting AMS in our Asia-Pacific region and across all sectors, including human and animal health too,” she added.  

Professor Shelley Dolan, Chief Executive at the Royal Melbourne Hospital and member of the Doherty Council, said that in the face of the mounting challenge (of antimicrobial resistance), the RMH Guidance Group has stood resolute for over 15 years.

“The group has been at the forefront of this battle against resistance, earning well deserved recognition as an international role model for AMS. I think we all recognise the extraordinary contribution of the NAPS to the health and wellbeing of our community over the last 10 years,” she said.