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Checklist for Core Elements of Hospital Antibiotic Stewardship Programs

The following checklist is a companion to Core Elements of Hospital Antibiotic Stewardship ProgramsThis checklist should be used to systematically assess key elements and actions to ensure optimal antibiotic prescribing and limit overuse and misuse of antibiotics in hospitals.  CDC recommends that all hospitals implement an Antibiotic Stewardship Program.

Facilities using this checklist should involve one or more knowledgeable staff to determine if the following principles and actions to improve antibiotic use are in place. The elements in this checklist have been shown in previous studies to be helpful in improving antibiotic use though not all of the elements might be feasible in all hospitals.

Leadership support Established at facility
A Does your facility have a formal, written statement of support from leadership that supports efforts to improve antibiotic use (antibiotic stewardship)? Yes No
B Does your facility receive any budgeted financial support for antibiotic stewardship activities (e.g., support for salary, training, or IT support)? Yes No
A Is there a physician leader responsible for program outcomes of stewardship activities at your facility? Yes No
Drug Expertise  
A Is there a pharmacist leader responsible for working to improve antibiotic use at your facility? Yes No

Key support for the antibiotic stewardship program
Does any of the staff below work with the stewardship leaders to improve antibiotic use?

B Clinicians Yes No
C Infection Prevention and Healthcare Epidemiology Yes No
D Quality Improvement    
E Microbiology (Laboratory) Yes No
F Information Technology (IT) Yes No
G Nursing Yes No
Actions to support optimal antibiotic use  
Policies Policy established
A Does your facility have a policy that requires prescribers to document in the medical record or during order entry a dose, duration, and indication for all antibiotic prescriptions? Yes No
B Does your facility have facility-specific treatment recommendations, based on national guidelines and local susceptibility, to assist with antibiotic selection for common clinical conditions? Yes No

Specific interventions to improve antibiotic use
Are the following actions to improve antibiotic prescribing conducted in your facility?

Broad interventions Action performed
C Is there a formal procedure for all clinicians to review the appropriateness of all antibiotics 48 hours after the initial orders (e.g. antibiotic time out)? Yes No
D Do specified antibiotic agents need to be approved by a physician or pharmacist prior to dispensing (i.e., pre-authorization) at your facility?                Yes No
E Does a physician or pharmacist review courses of therapy for specified antibiotic agents (i.e., prospective audit with feedback) at your facility? Yes No

Pharmacy-driven interventions
Are the following actions implemented in your facility?

Action performed
F Automatic changes from intravenous to oral antibiotic therapy in appropriate situations? Yes No
G Dose adjustments in cases of organ dysfunction? Yes No
H Dose optimization (pharmacokinetics/pharmacodynamics) to optimize the treatment of organisms with reduced susceptibility? Yes No
I Automatic alerts in situations where therapy might be unnecessarily duplicative? Yes No
J Time-sensitive automatic stop orders for specified antibiotic prescriptions? Yes No

Diagnosis and infections specific interventions
Does your facility have specific interventions in place to ensure optimal use of antibiotics to treat the following common infections?:

Action performed
K Community-acquired pneumonia Yes No
L Urinary tract infection Yes No
M Skin and soft tissue infections Yes No
N Surgical prophylaxis Yes No
O Empiric treatment of Methicillin-resistant Staphylococcus aureus (MRSA) Yes No
P Non-C. Difficile infection (CDI) antibiotics in new cases of CDI Yes No
Q Culture-proven invasive (e.g., blood stream) infections Yes No
Tracking: Monitoring antibiotic prescribing, use, and resistance  
Process measures Measure performed
A Does your stewardship program monitor adherence to a documentation policy (dose, duration, and indication)? Yes No
B Does your stewardship program monitor adherence to facility-specific treatment recommendations? Yes No
C Does your stewardship program monitor compliance with one of more of the specific interventions in place? Yes No
Antibiotic use and outcome measures Measure performed
D Does your facility track rates of C. difficile infection? Yes No
E Does your facility produce an antibiogram (cumulative antibiotic susceptibility report? Yes No
Does your facility monitor antibiotic use (consumption) at the unit and/or facility wide level by one of the following metrics: Measure performed
F By counts of antibiotic(s) administered to patients per day (Days of Therapy; DOT)? Yes No
G By number of grams of antibiotics used (Defined Daily Dose, DDD)? Yes No
H By direct expenditure for antibiotics (purchasing costs)? Yes No
Reporting information to staff on improving antibiotic use and resistance  
A Does you stewardship program share facility-specific reports on antibiotic use with prescribers? Yes No
B Has a current antibiogram been distributed to prescribers at your facility? Yes No
C Do prescribers ever receive direct, personalized communication about how they can improve their antibiotic prescribing? Yes No
A Does your stewardship program provide education to clinicians and other relevant staff on improving antibiotic prescribing?  Yes No

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