Background Start Smart then Focus Antimicrobial Stewardship (AMS) guidance for England was launched in November 2011 on European Antimicrobial Awareness Day.

Purpose To identify the extent of guideline implementation, whether the guidelines had improved AMS, and to collect examples of good practise.

Materials and Methods A web-based survey was developed using SurveyMonkey software, piloted, and then distributed through the microbiology, infectious diseases and pharmacy networks in July 2012.

Results There were 74 responses (44%) to the Start Smart then Focus (SSTF) guidance by September. SSTF was rated excellent or good by 65% for making AMS a Trust priority; by 57% for improving their AMS infrastructure; by 51% for improving prescribing practise; by 57% for improving audit and by 31% for improved usage reporting. Only 12% to 22% thought it was poor or less than satisfactory for the same criteria.

A formal review of SSTF has been done by 41%, with 17% planning to do so. 86% had done an informal review. 52% had developed an action plan.

The main barriers to implementation were a lack of microbiology/infectious diseases time, then pharmacist time. An established AMS group, an enthusiastic pharmacist or microbiologist, or adequate time, were the main facilitators.

Putting the indication and duration or a review date on in-patient antimicrobial prescriptions were in place prior to SSTF in 67% and 73% of centres respectively. Since SSTF a further 9% have started and another 13% and 10% plan to implement these suggestions by April 2013.

Additional antimicrobial ward rounds have started or are planned since SSTF in medical wards by 20%, surgical wards by 19% and paediatrics by 10% of centres.

Conclusions The Start Smart then Focus Antimicrobial Stewardship guidance has helped to further implement AMS in England.

No conflict of interest.