Antimicrobial Stewardship Processes Measurement

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 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.

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* 1. Please write your work ID

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* 2. What region are you in? (Please mention what hospital you are in)

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* 3. What are you working for?

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* 4. Sex

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* 5. Nationality

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* 6. please answer the following questions,by leting us know if they are established in your facility.

	Yes	No
Leadership Does your facility have a formal, written statement of support from leadership that supports efforts to improve antibiotic use (antibiotic stewardship)?	Leadership Does your facility have a formal, written statement of support from leadership that supports efforts to improve antibiotic use (antibiotic stewardship)? Yes	Leadership Does your facility have a formal, written statement of support from leadership that supports efforts to improve antibiotic use (antibiotic stewardship)? No
Do your facility have antibiotics committee ?	Do your facility have antibiotics committee ? Yes	Do your facility have antibiotics committee ? No
Are you member of regional antibiotics committee?	Are you member of regional antibiotics committee? Yes	Are you member of regional antibiotics committee? No
Is there a physician leader responsible for program outcomes of stewardship activities at your facility?	Is there a physician leader responsible for program outcomes of stewardship activities at your facility? Yes	Is there a physician leader responsible for program outcomes of stewardship activities at your facility? No
Is there a pharmacist leader responsible for working to improve antibiotic use at your facility?	Is there a pharmacist leader responsible for working to improve antibiotic use at your facility? Yes	Is there a pharmacist leader responsible for working to improve antibiotic use at your facility? No
Does the clinician work with the stewardship leaders to improve antibiotic use?	Does the clinician work with the stewardship leaders to improve antibiotic use? Yes	Does the clinician work with the stewardship leaders to improve antibiotic use? No
Does the Infection Prevention and Healthcare Epidemiologist work with the stewardship leaders to improve antibiotic use?	Does the Infection Prevention and Healthcare Epidemiologist work with the stewardship leaders to improve antibiotic use? Yes	Does the Infection Prevention and Healthcare Epidemiologist work with the stewardship leaders to improve antibiotic use? No
Does the Quality Improvement person work with the stewardship leaders to improve antibiotic use?	Does the Quality Improvement person work with the stewardship leaders to improve antibiotic use? Yes	Does the Quality Improvement person work with the stewardship leaders to improve antibiotic use? No
Does the Microbiologist work with the stewardship leaders to improve antibiotic use?	Does the Microbiologist work with the stewardship leaders to improve antibiotic use? Yes	Does the Microbiologist work with the stewardship leaders to improve antibiotic use? No
Does the Information Technologist (IT)work with the stewardship leaders to improve antibiotic use?	Does the Information Technologist (IT)work with the stewardship leaders to improve antibiotic use? Yes	Does the Information Technologist (IT)work with the stewardship leaders to improve antibiotic use? No
Does the Nurse work with the stewardship leaders to improve antibiotic use?	Does the Nurse work with the stewardship leaders to improve antibiotic use? Yes	Does the Nurse work with the stewardship leaders to improve antibiotic use? No

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* 7.
was the policy established

	Yes	No
Does your facility have an electronic order prescription for antibiotics taht require priscriber to document the antibiotics dose, route of adminstration and duration ?	Does your facility have an electronic order prescription for antibiotics taht require priscriber to document the antibiotics dose, route of adminstration and duration ? Yes	Does your facility have an electronic order prescription for antibiotics taht require priscriber to document the antibiotics dose, route of adminstration and duration ? No
Does your facility have a manual order prescription for antibiotics taht require priscriber to document the antibiotics dose, route of adminstration and duration ?	Does your facility have a manual order prescription for antibiotics taht require priscriber to document the antibiotics dose, route of adminstration and duration ? Yes	Does your facility have a manual order prescription for antibiotics taht require priscriber to document the antibiotics dose, route of adminstration and duration ? No
Does your facility have facility-specific treatment recommendations, based on national guidelines and local susceptibility, to assist with antibiotic selection for common clinical conditions for adult ?	Does your facility have facility-specific treatment recommendations, based on national guidelines and local susceptibility, to assist with antibiotic selection for common clinical conditions for adult ? Yes	Does your facility have facility-specific treatment recommendations, based on national guidelines and local susceptibility, to assist with antibiotic selection for common clinical conditions for adult ? No
Does your facility have facility-specific treatment recommendations, based on national guidelines and local susceptibility, to assist with antibiotic selection for common clinical conditions for pediatric ?	Does your facility have facility-specific treatment recommendations, based on national guidelines and local susceptibility, to assist with antibiotic selection for common clinical conditions for pediatric ? Yes	Does your facility have facility-specific treatment recommendations, based on national guidelines and local susceptibility, to assist with antibiotic selection for common clinical conditions for pediatric ? No
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)?	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	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)? No
Do specified antibiotic agents need to be approved by a physician or pharmacist prior to dispensing (i.e., pre-authorization) at your facility?	Do specified antibiotic agents need to be approved by a physician or pharmacist prior to dispensing (i.e., pre-authorization) at your facility? Yes	Do specified antibiotic agents need to be approved by a physician or pharmacist prior to dispensing (i.e., pre-authorization) at your facility? No
Does a physician or pharmacist review courses of therapy for specified antibiotic agents (i.e., prospective audit with feedback) at your facility?	Does a physician or pharmacist review courses of therapy for specified antibiotic agents (i.e., prospective audit with feedback) at your facility? Yes	Does a physician or pharmacist review courses of therapy for specified antibiotic agents (i.e., prospective audit with feedback) at your facility? No

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* 8.
Pharmacy driven interventions

Are the following implemented in your facility?

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

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* 9.
Diagnosis and infections specific inerventions
Does your facility have specific interventions in place to ensure optimal use of antibiotics to treat the following common infections?

	Yes	No
Community-acquired pneumonia	Community-acquired pneumonia Yes	Community-acquired pneumonia No
Urinary tract infection	Urinary tract infection Yes	Urinary tract infection No
Skin and soft tissue infections	Skin and soft tissue infections Yes	Skin and soft tissue infections No
Surgical prophylaxis	Surgical prophylaxis Yes	Surgical prophylaxis No
Empiric treatment of Methicillin-resistant Staphylococcus aureus (MRSA)	Empiric treatment of Methicillin-resistant Staphylococcus aureus (MRSA) Yes	Empiric treatment of Methicillin-resistant Staphylococcus aureus (MRSA) No

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* 10.
Tracking: Monitoring antibiotic prescribing,use,resistance measure performed <o:p></o:p>

	Yes	No
Does your stewardship program monitor adherence to a documentation policy (dose, duration, and indication)?	Does your stewardship program monitor adherence to a documentation policy (dose, duration, and indication)? Yes	Does your stewardship program monitor adherence to a documentation policy (dose, duration, and indication)? No
Does your stewardship program monitor adherence to facility-specific treatment recommendations?	Does your stewardship program monitor adherence to facility-specific treatment recommendations? Yes	Does your stewardship program monitor adherence to facility-specific treatment recommendations? No
Does your stewardship program monitor compliance with one of more of the specific interventions in place?	Does your stewardship program monitor compliance with one of more of the specific interventions in place? Yes	Does your stewardship program monitor compliance with one of more of the specific interventions in place? No
Antibiotic use and outcome measures <o:p></o:p> Does your facility track rates of difficile infection?	Antibiotic use and outcome measures <o:p></o:p> Does your facility track rates of difficile infection? Yes	Antibiotic use and outcome measures <o:p></o:p> Does your facility track rates of difficile infection? No
Does your facility produce an antibiogram (cumulative antibiotic susceptibility report?	Does your facility produce an antibiogram (cumulative antibiotic susceptibility report? Yes	Does your facility produce an antibiogram (cumulative antibiotic susceptibility report? No

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* 11.
Does your facility monitor antibiotic use (consumption) at the unit and/or facility wide level by one of the following metrics:

	Yes	No
By counts of antibiotic(s) administered to patients per day (Days of Therapy; DOT)?	By counts of antibiotic(s) administered to patients per day (Days of Therapy; DOT)? Yes	By counts of antibiotic(s) administered to patients per day (Days of Therapy; DOT)? No
By number of grams of antibiotics used (Defined Daily Dose, DDD)?	By number of grams of antibiotics used (Defined Daily Dose, DDD)? Yes	By number of grams of antibiotics used (Defined Daily Dose, DDD)? No
By direct expenditure for antibiotics (purchasing costs)?	By direct expenditure for antibiotics (purchasing costs)? Yes	By direct expenditure for antibiotics (purchasing costs)? No
Reporting information to staff on improving antibiotic use and resistance: Does you stewardship program share facility-specific reports on antibiotic use with prescribers?	Reporting information to staff on improving antibiotic use and resistance: Does you stewardship program share facility-specific reports on antibiotic use with prescribers? Yes	Reporting information to staff on improving antibiotic use and resistance: Does you stewardship program share facility-specific reports on antibiotic use with prescribers? No
Reporting information to staff on improving antibiotic use and resistance: Has a current antibiogram been distributed to prescribers at your facility?	Reporting information to staff on improving antibiotic use and resistance: Has a current antibiogram been distributed to prescribers at your facility? Yes	Reporting information to staff on improving antibiotic use and resistance: Has a current antibiogram been distributed to prescribers at your facility? No
Reporting information to staff on improving antibiotic use and resistance: Do prescribers ever receive direct, personalized communication about how they can improve their antibiotic prescribing?	Reporting information to staff on improving antibiotic use and resistance: Do prescribers ever receive direct, personalized communication about how they can improve their antibiotic prescribing? Yes	Reporting information to staff on improving antibiotic use and resistance: Do prescribers ever receive direct, personalized communication about how they can improve their antibiotic prescribing? No
Education Does your stewardship program provide education to clinicians and other relevant staff on improving antibiotic prescribing?	Education Does your stewardship program provide education to clinicians and other relevant staff on improving antibiotic prescribing? Yes	Education Does your stewardship program provide education to clinicians and other relevant staff on improving antibiotic prescribing? No

Antimicrobial Stewardship Processes Measurement

Question Title

* 1. Please write your work ID

Question Title

* 2. What region are you in? (Please mention what hospital you are in)

Question Title

* 3. What are you working for?

Question Title

* 4. Sex

Question Title

* 5. Nationality

Question Title

* 6. please answer the following questions,by leting us know if they are established in your facility.

Question Title

* 7.
was the policy established

Question Title

* 8.
Pharmacy driven interventions

Are the following implemented in your facility?

Question Title

* 9.
Diagnosis and infections specific inerventions
Does your facility have specific interventions in place to ensure optimal use of antibiotics to treat the following common infections?

Question Title

* 10.
Tracking: Monitoring antibiotic prescribing,use,resistance measure performed <o:p></o:p>

Question Title

* 11.
Does your facility monitor antibiotic use (consumption) at the unit and/or facility wide level by one of the following metrics:

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* 12. Do your facility have a post marketing surveillance ?

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* 13. Do your facility have a drug quality reporting system?

Question Title

* 1. Please write your work ID

Question Title

* 2. What region are you in? (Please mention what hospital you are in)

Question Title

* 3. What are you working for?

Question Title

* 4. Sex

Question Title

* 5. Nationality

Question Title

* 6. please answer the following questions,by leting us know if they are established in your facility.

Question Title

* 7. was the policy established

Question Title

* 8. Pharmacy driven interventions Are the following implemented in your facility?

Question Title

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

Question Title

* 10. Tracking: Monitoring antibiotic prescribing,use,resistance measure performed <o:p></o:p>

Question Title

* 11. Does your facility monitor antibiotic use (consumption) at the unit and/or facility wide level by one of the following metrics:

Question Title

* 12. Do your facility have a post marketing surveillance ?

Question Title

* 13. Do your facility have a drug quality reporting system?

* 7.
was the policy established

* 8.
Pharmacy driven interventions

Are the following implemented in your facility?

* 9.
Diagnosis and infections specific inerventions
Does your facility have specific interventions in place to ensure optimal use of antibiotics to treat the following common infections?

* 10.
Tracking: Monitoring antibiotic prescribing,use,resistance measure performed <o:p></o:p>

* 11.
Does your facility monitor antibiotic use (consumption) at the unit and/or facility wide level by one of the following metrics: