Post Detail

On 6 September 2025, Seti Provincial Hospital in Dhangadhi, Kailali, became the venue for an important milestone in Nepal’s efforts to strengthen antimicrobial stewardship. The hospital hosted the Refresher Training for the Hospital National Antimicrobial Prescribing Survey II (NAPS II), under the CAPTURA project, with support from the International Vaccine Institute (IVI) and the National Centre for Antimicrobial Stewardship (NCAS), Australia.

The training was designed to prepare hospital teams for the second round of NAPS implementation, equipping them with the technical skills, confidence, and shared understanding needed to ensure high-quality data collection and meaningful stewardship outcomes.

Why does NAPS Matters?

Antimicrobial resistance (AMR) is one of the most pressing global health challenges, and inappropriate prescribing remains a key driver. Recognizing this, the National Antimicrobial Prescribing Survey (NAPS) was developed as a standardized, web-based auditing tool. It evaluates antimicrobial use through two critical indicators: compliance with guidelines and appropriateness of prescribing.

In Nepal, NAPS was first piloted in Phase I, which established baseline data on antimicrobial use across several hospitals. Phase II builds on that foundation, focusing on refining auditing practices, ensuring consistency, and translating findings into actionable improvements in hospital prescribing.

For Seti Provincial Hospital, the refresher training represented an opportunity to strengthen its stewardship activities and align practices with both national and international standards.

Opening Session

The program began with a warm welcome from Mr. Gauri Joshi, who hosted the opening session. Dr. Pradip Mishra delivered introductory remarks, outlining the broader goals of the project and the importance of reliable data in combating AMR. Dr. Hem Raj Pandey, the Chief Medical Superintendent of Seti Provincial Hospital, followed with a welcome address, highlighting the hospital’s commitment to quality improvement.

Adding to the context, Ms. Kamala Bist, Hospital Nursing Administrator, presented reflections on the findings and challenges from NAPS Phase I. Her insights underscored the need for stronger documentation, consistency in auditing practices, and better alignment with clinical guidelines. These reflections created a thoughtful bridge between past experiences and the objectives of the day’s training.

Training Sessions

The technical sessions were led by Ms. Sanju Maharjan, Program Manager at Anweshan Pvt. Ltd., whose facilitation combined detailed explanation with hands-on learning. The morning segment focused on familiarizing participants with the NAPS interface, operational definitions, and data entry processes. Through case-based reviews of Phase I, auditors revisited real scenarios, discussing strengths and identifying gaps in previous audits.

A dedicated question-and-answer session allowed participants to raise concerns about issues faced during the first round of NAPS, ranging from incomplete documentation to uncertainties in interpreting guideline adherence. This interactive approach ensured that the training was grounded in practical realities rather than abstract theory.

In the afternoon, the focus shifted toward applied practice. Participants reviewed ward-level Cardex sheets and engaged in sample audits using real patient records from different departments. Working in pairs, they conducted hands-on audits, presented their findings, and engaged in group discussions. This not only sharpened auditing skills but also built confidence in managing real-world challenges.

Key Lessons and Reflections

Several important lessons emerged from the day’s training:

• Documentation is critical: Clear and consistent documentation remains a major determinant of audit quality.
• Guideline adherence needs reinforcement: Auditors emphasized the importance of using only locally or nationally endorsed guidelines when assessing compliance.
• Collaborative learning adds value: Paired exercises encourage dialogue, helping auditors refine their judgment and approach.

By revisiting these lessons, participants were better prepared to improve the accuracy and reliability of Phase II audits.

Participants and Collaboration

The training brought together a diverse group of professionals, including hospital leadership, physicians, nursing staff, clinical pharmacists, and designated auditors. This multidisciplinary participation reflected the hospital’s recognition that antimicrobial stewardship is not the responsibility of one group alone, but a shared mission requiring collaboration across departments.

The active involvement of different cadres also ensured that the discussions were enriched by multiple perspectives, from clinical decision-making to nursing documentation and pharmacy review.

Moving Forward:

The refresher training concluded with a forward-looking planning session. Participants outlined the roadmap for upcoming data collection, discussed timelines, and clarified operational queries. This collective exercise reinforced their shared responsibility in ensuring the success of NAPS II at Seti Provincial Hospital.

By combining theoretical review with practical, case-based exercises, the refresher training not only strengthened technical skills but also built a sense of ownership and collaboration among hospital staff. The lessons learned will directly inform the upcoming round of NAPS, supporting both hospital-level improvements and broader national antimicrobial stewardship initiatives.

As antimicrobial resistance continues to challenge health systems globally, efforts like the NAPS II refresher training at Seti Provincial Hospital play a vital role in safeguarding the effectiveness of antimicrobials for generations to come.