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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 Programs. This 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 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 supportEstablished at facility
Does your facility have a formal, written statement of support from leadership that supports efforts to improve antibiotic use (antibiotic stewardship)?YesNo
Does your facility receive any budgeted financial support for antibiotic stewardship activities (e.g., support for salary, training, or IT support)?YesNo

AccountabilityEstablished at facility
Is there a physician leader responsible for program outcomes of stewardship activities at your facility?YesNo

Drug ExpertiseEstablished at facility
Is there a pharmacist leader responsible for working to improve antibiotic use at your facility?YesNo

Key support for the antibiotic stewardship program

Does any of the staff below work with the stewardship leaders to improve antibiotic use?Established at facility
Infection Prevention and Healthcare EpidemiologyYesNo
Quality Improvement  
Microbiology (Laboratory)YesNo
Information Technology (IT)YesNo

Actions to support optimal antibiotic use

PoliciesPolicy established
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?YesNo
Does your facility have facility-specific treatment recommendations, based on national guidelines and local susceptibility, to assist with antibiotic selection for common clinical conditions?YesNo

Specific interventions to improve antibiotic use

Are the following actions to improve antibiotic prescribing conducted in your facility?
Broad interventions
Action performed
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)?YesNo
Do specified antibiotic agents need to be approved by a physician or pharmacist prior to dispensing (i.e., pre-authorization) at your facility?               YesNo
Does a physician or pharmacist review courses of therapy for specified antibiotic agents (i.e., prospective audit with feedback) at your facility?YesNo

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Pharmacy-driven interventions

Are the following actions implemented in your facility?Action performed
Automatic changes from intravenous to oral antibiotic therapy in appropriate situations?YesNo
Dose adjustments in cases of organ dysfunction?YesNo
Dose optimization (pharmacokinetics/pharmacodynamics) to optimize the treatment of organisms with reduced susceptibility?YesNo
Automatic alerts in situations where therapy might be unnecessarily duplicative?YesNo
Time-sensitive automatic stop orders for specified antibiotic prescriptions?YesNo

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
Community-acquired pneumoniaYesNo
Urinary tract infectionYesNo
Skin and soft tissue infectionsYesNo
Surgical prophylaxisYesNo
Empiric treatment of Methicillin-resistant Staphylococcus aureus (MRSA)YesNo
Non-C. Difficile infection (CDI) antibiotics in new cases of CDIYesNo
Culture-proven invasive (e.g., blood stream) infectionsYesNo

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Tracking: Monitoring antibiotic prescribing, use, and resistance

Process measuresMeasure performed
Does your stewardship program monitor adherence to a documentation policy (dose, duration, and indication)?YesNo
Does your stewardship program monitor adherence to facility-specific treatment recommendations?YesNo
Does your stewardship program monitor compliance with one of more of the specific interventions in place?YesNo
Antibiotic use and outcome measuresMeasure performed
Does your facility track rates of C. difficile infection?YesNo
Does your facility produce an antibiogram (cumulative antibiotic susceptibility report?YesNo
Does your facility monitor antibiotic use (consumption) at the unit and/or facility wide level by one of the following metrics:Measure performed
By counts of antibiotic(s) administered to patients per day (Days of Therapy; DOT)?YesNo
By number of grams of antibiotics used (Defined Daily Dose, DDD)?YesNo
By direct expenditure for antibiotics (purchasing costs)?YesNo


Reporting information to staff on improving antibiotic use and resistanceMeasure performed
Does you stewardship program share facility-specific reports on antibiotic use with prescribers?YesNo
Has a current antibiogram been distributed to prescribers at your facility?YesNo
Do prescribers ever receive direct, personalized communication about how they can improve their antibiotic prescribing?YesNo

EducationMeasure performed
Does your stewardship program provide education to clinicians and other relevant staff on improving antibiotic prescribing? YesNo

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