United Nations AMR action: development and early validation of a real-time, dual-phase antimicrobial stewardship dashboard for full-pathway monitoring of empirical and subsequent antibiotic therapy

Background Antimicrobial resistance (AMR) is a major global health challenge, which caused an estimated 1.27 million deaths in 2019 and is projected to contribute to 10 million deaths annually by 2050. Strengthening antimicrobial stewardship (AMS) is critical to addressing this threat. However, stewardship monitoring systems remain fragmented and retrospective, limiting timely action. The COVID-19 pandemic further exposed these limitations, highlighting the need for innovative, accessible and real-time solutions to improve stewardship and patient safety. Methods A four-phase methodology was employed. Phase 1 comprised a systematic review of antimicrobial stewardship (AMS) strategies before and during the COVID-19 pandemic. Phase 2 involved retrospective analysis of 640 patient records, while Phase 3 surveyed 240 healthcare professionals regarding AMS knowledge, attitudes and practices. Phase 4 focused on user-centred dashboard development. Validation incorporated technical testing, expert review, and patient and public involvement to assess accuracy, usability, and feasibility. Results The dashboard enables dual-phase monitoring of empirical prescribing and subsequent antibiotic therapy across the antimicrobial pathway. Features include real-time visualisation, interactive filtering by temporal, spatial and clinical variables, and ward-level monitoring to support quality improvement. Early validation combined technical accuracy testing and expert feedback. High concordance was demonstrated between source data and dashboard outputs, with responsive performance under simulated load. Reviewers rated the dashboard favourably for usability, clinical relevance, feasibility, and operational resilience. Conclusions This innovative AMS dashboard shifts stewardship from retrospective audit to proactive decision support. Its low-infrastructure dual-phase design offers sustainability within the NHS and scalability across healthcare settings, supporting global AMR action and the achievement of sustainable development (SDG) goals.