Development and Implementation of a Dynamic Antimicrobial Stewardship Dashboard: Real-Time Monitoring from "Start Smart" to "Then Focus"

Antimicrobial resistance poses an escalating global health threat, with bacterial resistance causing 1.27 million deaths in 2019 and projected to claim 10 million lives annually by 2050. Antimicrobial stewardship (AMS) programmes represent critical interventions, yet current monitoring systems remain fragmented and retrospective, limiting real-time clinical decision support.
This study aimed to develop and validate a dynamic AMS dashboard aligned with the UK’s Start Smart, Then Focus framework, providing comprehensive real-time monitoring from empirical therapy initiation through discharge. Using a systematic four-phase methodology informed by a literature review, retrospective medical record analysis, and a cross-sectional pharmacist survey, the dashboard was developed through evidence synthesis, user-centred design, Excel-based implementation, and clinical validation.
The dashboard integrates dual-phase monitoring, interactive filtering, real-time prescribing and microbiology visualisation, and ward-level quality improvement support. Validation confirmed robust technical performance, clinical relevance, and usability across multidisciplinary teams. This work demonstrates a sustainable, Excel-based innovation transforming stewardship monitoring from retrospective audit to proactive clinical decision support.