Post Detail

Kathmandu, Nepal, June 2025

Nepal has successfully completed Phase I of its first-ever Hospital National Antimicrobial Prescribing Survey (Hospital NAPS), a key step in improving the understanding of antimicrobial prescribing practices across the country. Conducted as part of the CAPTURA II/TACE project, the survey was led by the International Vaccine Institute (IVI) and Australia’s National Centre for Antimicrobial Stewardship (NCAS), funded by UKAID and the Fleming Fund, with project management by Mott MacDonald. The local implementation was handled by Anweshan, a public health research and policy consulting firm based in Nepal. The NAPS aims to generate reliable national data to support better design and implementation of antimicrobial stewardship interventions.

Why Hospital NAPS?

The Hospital NAPS offers a standardised and practical approach for auditing antimicrobial use in healthcare settings. Delivered through a web-based platform, Hospital NAPS enables consistent data collection and supports comparison and benchmarking across hospitals in Nepal and internationally. A key feature of NAPS is its clinician-centred design, which facilitates automated report generation without the need for manual data analysis. This reduces the time burden on clinicians and enables the generation of meaningful reports directly from collected data, without requiring specialised expertise in data analysis, supporting the provision of timely and informed feedback. Indications in NAPS are also recorded at a detailed level, reflecting specific diagnoses as documented in clinical records. This granularity enhances the relevance of feedback at the individual prescriber level. Importantly, these data are also structured to support aggregation, enabling reporting at institutional and national levels. Another distinguishing feature is the inclusion of an ‘appropriateness assessment’ metric, which extends beyond guideline compliance by incorporating clinical context into the evaluation process. This allows prescribing to be assessed in scenarios such as directed therapy, complex infections, or where no relevant guidelines exist, thereby supporting a more comprehensive and nuanced assessment of antimicrobial use across a broad range of clinical situations.

Phase I at tertiary healthcare institutions

Phase I of the survey took place from March to June 2025 at two major tertiary healthcare centres: National Academy of Medical Sciences Bir Hospital in Kathmandu and Seti Provincial Hospital in Dhangadhi under the leadership of Ministry of Health and Population (MoHP)’s Quality Standards and Regulation Division (QSRD) and technical support from NCAS and Anweshan team.

Project timeline and key activities

The project began with ethical approval from the Nepal Health Research Council (NHRC) in February 2025, followed by institutional approval from the National Academy of Medical Sciences (NAMS) for Bir Hospital. Initial assessments of hospital data systems, antimicrobial prescribing patterns, laboratory diagnostics, and patient records informed the survey methodology. In March, briefings with hospital leaders and staff clarified objectives and gained institutional commitment.

Training and capacity building

Building local capacity was central to the project. Between 18 and 20 March 2025, global experts Dr Rod James and Mr Ron Cheah from NCAS Australia conducted training in Kathmandu, attended by 28 healthcare professionals, including nurses, Auxiliary health workers and data managers.  A parallel training session took place at Seti Provincial Hospital from 5 to 7 April, with participation from local health officials. Additional refresher training ensured consistency in data collection.

Data collection and quality assurance

At Seti Hospital, data was collected from 27 April to 3 May 2025, reviewing 124 patient cases by 10 trained hospital nursing staffs. Bir Hospital completed data collection from 4 to 17 May, auditing 294 patient cases across departments including intensive care and surgical units. In total 20 nursing staff from both sites were mobilized for conducting prescription surveys. On 14 May, Dr Saroj Sharma from QSRD led a monitoring visit to Bir Hospital, ensuring data quality and providing necessary guidance.

Key Findings

• National guidelines are widely accessible, easy to interpret, and comprehensive, enabling effective assessment of a broad range of conditions.
• Very few instances of unavailable guidelines were reported, with low counts observed in NAMS (0.2%) and none in Seti (0%).
• There is evident clinical expertise within the country to conduct appropriate assessments, as reflected by the low proportion of cases deemed not assessable in both hospitals.
• The prevalence of inappropriate care is in line with global averages for inpatient settings—43.8% globally, and 67.5% in low-income contexts.[1]
• Prescribing practices for COPD were generally appropriate, with no major concerns identified, while treatment for TB and acute hepatic encephalopathy was overall well-aligned with clinical standards.
• Surgical prophylaxis adherence to guidelines was particularly low at both the sites.
• Ceftriaxone was commonly prescribed and most misused antibiotic at both sites.

Commitment to improvement

Both hospitals have committed to using these findings to initiate institutional improvements. The survey has provided Nepal with its first comprehensive national dataset on antimicrobial prescribing and has encouraged greater transparency, education, and collaborative stewardship.

As Nepal continues to tackle antimicrobial resistance (AMR), this survey provides essential insights to guide policy and clinical practice improvements, forming the basis for future efforts and targeted interventions nationwide.

[1] REF: https://jogh.org/2025/jogh-15-04023