ANTIMICROBIAL STEWARDSHIP PROGRAMMES IN HOSPITALS

SESSION THREE: INTERACTIVE WORKSHOP SESSIONS

CHECKLIST FOR CORE ELEMENTS OF HOSPITAL ANTIMICROBIAL STEWARDSHIP PROGRAMMES& CORE MEMMBERS OF MULTIDISCIPLINARY ANTIMICROBIAL STEWARDSHIP TEAMS
CORE MEMBERS OF MULTIDISCIPLINARY ANTIMICROBIAL STEWARDSHIP TEAMS: LEADERSHIP & ACCOUNTABILITY
LEADERSHIP FEASIBLE CHALLENGES STRATEGY
Is there a senior executive responsible for the
overall leadership for antimicrobial management
❑Yes
and control, and the development and Kindly
type in a
implementation of an antimicrobial stewardship ❑No
slash “/”
programme? mark to
Does your facility have a formal, written indicate
yes or no.
statement of support from leadership that
supports efforts to improve antimicrobial use ❑Yes
(antimicrobial stewardship)? ❑No

Does your facility receive any budgeted financial

support for antimicrobial stewardship activities
(e.g., support for salary, training, or IT support)? ❑Yes
❑No

ACCOUNTABILITY
Is there a physician leader responsible for
program outcomes of stewardship activities at
❑Yes
your facility?
❑No

DRUG EXPERTISE
Is there a pharmacist leader responsible for
working to improve antimicrobial use at your
facility? ❑Yes
❑No

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 ANTIMICROBIAL STEWARDSHIP PROGRAMMES IN HOSPITALS
SESSION THREE: INTERACTIVE WORKSHOP SESSIONS

CHECKLIST FOR CORE ELEMENTS OF HOSPITAL ANTIMICROBIAL STEWARDSHIP PROGRAMMES & CORE MEMMBERS OF MULTIDISCIPLINARY ANTIMICROBIAL STEWARDSHIP TEAMS
CORE MEMBERS OF MULTIDISCIPLINARY STEWARDSHIP TEAMS: GOVERNANCE AND COMMITTEES
KEY SUPPORT FOR THE ANTIMICROBIAL STEWARDSHIP PROGRAMME FEASIBLE CHALLENGES STRATEGY
Does your organisation have:

❑Yes
 Pharmacy and Therapeutics Committee
❑No

❑Yes
 Infection Prevention and Control Committee
❑No

❑Yes
❑No
 Patient Medication Safety Committee

❑Yes
❑No
 AMS Committee:

❑Yes
❑No
o Executive representative

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 ANTIMICROBIAL STEWARDSHIP PROGRAMMES IN HOSPITALS
SESSION THREE: INTERACTIVE WORKSHOP SESSIONS

❑Yes
❑No
o Infectious disease physician

❑Yes
❑No
o Clinical pharmacist / or its equivalent
pharmacist

❑Yes
❑No
o Clinical microbiologist

❑Yes
o Infection prevention professionals
❑No

❑Yes
o Nursing leadership
❑No

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 ANTIMICROBIAL STEWARDSHIP PROGRAMMES IN HOSPITALS
SESSION THREE: INTERACTIVE WORKSHOP SESSIONS

❑Yes
o Hospital epidemiologist
❑No

❑Yes
o Information systems specialist
❑No

❑Yes
 AMS Team
❑No

❑Yes
❑No
o Infectious diseases physician

❑Yes
❑No
o Clinical pharmacist

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 ANTIMICROBIAL STEWARDSHIP PROGRAMMES IN HOSPITALS
SESSION THREE: INTERACTIVE WORKSHOP SESSIONS

❑Yes
❑No
o Clinical microbiologist

❑Yes
❑No
o Infection prevention professional

❑Yes
❑No
o Clinical nurse consultant or clinical nurse
educator

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 ANTIMICROBIAL STEWARDSHIP PROGRAMMES IN HOSPITALS
SESSION THREE: INTERACTIVE WORKSHOP SESSIONS

CHECKLIST FOR CORE ELEMENTS OF HOSPITAL ANTIMICROBIAL STEWARDSHIP PROGRAMMES & CORE MEMMBERS OF MULTIDISCIPLINARY ANTIMICROBIAL STEWARDSHIP TEAMS
CORE ELEMENTS OF HOSPITAL ANTIMICROBIAL STEWARDSHIP PROGRAMMES
POLICIES - GUIDELINES - STANDARDS FEASIBLE CHALLENGES STRATEGY
Does your facility have an authoritive and credible ❑Yes
antimicrobial policy? (refer policy statement) ❑No

Does your facility have a policy that requires ❑Yes

prescribers to document in the medical record or ❑No
during order entry a dose, duration, and indication for
all antimicrobial prescriptions?
Does your facility have facility-specific standard ❑Yes
treatment guidelines which are based on national ❑No
guidelines and local susceptibility data?

Does your facility have an essentials medicine list? ❑Yes

❑No

Does your facility have a formulary? ❑Yes

❑No

Does you facility have a list of restricted antimicrobials ❑Yes

and a ‘protocol’ for approval and use of restricted ❑No
antimicrobials?

Does your facility have infection prevention and ❑Yes

control policy and guidelines; e.g. hand washing? ❑No

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 ANTIMICROBIAL STEWARDSHIP PROGRAMMES IN HOSPITALS
SESSION THREE: INTERACTIVE WORKSHOP SESSIONS

CHECKLIST FOR CORE ELEMENTS OF HOSPITAL ANTIMICROBIAL STEWARDSHIP PROGRAMMES & CORE MEMMBERS OF MULTIDISCIPLINARY ANTIMICROBIAL STEWARDSHIP TEAMS
WHAT NEXT - SPECIFIC INTERVENTIONS TO IMPROVE ANTIMICROBIAL USE
FEASIBLE CHALLENGES STRATEGY
BROAD INTERVENTIONS
Is there a formal procedure for all clinicians to review the
appropriateness of all antimicrobials 48 hours after the
initial orders (e.g. antimicrobial time out)?
❑Yes
❑No

Do specified antimicrobial agents have a specific criteria ❑Yes

for use and need to be approved prior to dispensing (i.e., ❑No
pre-authorization) at your facility?

Does a physician or pharmacist review courses of ❑Yes

therapy for specified antimicrobial agents (i.e., ❑No
prospective audit with feedback) at your facility?

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 ANTIMICROBIAL STEWARDSHIP PROGRAMMES IN HOSPITALS
SESSION THREE: INTERACTIVE WORKSHOP SESSIONS

CHECKLIST FOR CORE ELEMENTS OF HOSPITAL ANTIMICROBIAL STEWARDSHIP PROGRAMMES & CORE MEMMBERS OF MULTIDISCIPLINARY ANTIMICROBIAL STEWARDSHIP TEAMS
WHAT NEXT - SPECIFIC INTERVENTIONS TO IMPROVE ANTIMICROBIAL USE
PHARMACY DRIVEN INTERVENTIONS
Protocol for changing from intravenous to oral
antimicrobial therapy in appropriate situations?

❑Yes
❑No

Protocol for dose adjustments in cases of organ

dysfunction?

❑Yes
❑No

Protocol for alerts in situations where therapy might be ❑Yes

unnecessarily duplicative? ❑No

Time-sensitive automatic stop orders for specified ❑Yes

antimicrobial prescriptions? ❑No

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 ANTIMICROBIAL STEWARDSHIP PROGRAMMES IN HOSPITALS
SESSION THREE: INTERACTIVE WORKSHOP SESSIONS

CHECKLIST FOR CORE ELEMENTS OF HOSPITAL ANTIMICROBIAL STEWARDSHIP PROGRAMMES & CORE MEMMBERS OF MULTIDISCIPLINARY ANTIMICROBIAL STEWARDSHIP TEAMS
WHAT NEXT - SPECIFIC INTERVENTIONS TO IMPROVE ANTIMICROBIAL USE

ANTIMICROBIAL USE AND OUTCOME MEASURES

Does your facility track rates of C. difficile infection?

❑Yes
❑No

Does your facility produce an antibiogram (cumulative

antimicrobial susceptibility report?

❑Yes
❑No

Does your facility monitor antimicrobial use

(consumption) at the unit and/or facility wide level by
one of the following metrics:

 By counts of antimicrobial(s) administered to ❑Yes

patients per day (Days of Therapy)? ❑No

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 ANTIMICROBIAL STEWARDSHIP PROGRAMMES IN HOSPITALS
SESSION THREE: INTERACTIVE WORKSHOP SESSIONS

CHECKLIST FOR CORE ELEMENTS OF HOSPITAL ANTIMICROBIAL STEWARDSHIP PROGRAMMES & CORE MEMMBERS OF MULTIDISCIPLINARY ANTIMICROBIAL STEWARDSHIP TEAMS
WHAT NEXT - SPECIFIC INTERVENTIONS TO IMPROVE ANTIMICROBIAL USE

 By number of grams of antimicrobials used ❑Yes

(Defined Daily Dose, DDD)? ❑No

 By direct expenditure for antimicrobials

(purchasing costs)?
❑Yes
❑No

EDUCATION & BEHAVIOUR CHANGE

Does your stewardship program provide education to
clinicians and other relevant staff on improving
❑Yes
antimicrobial prescribing?
❑No

Does you stewardship program share facility-specific ❑Yes

reports on antimicrobial use with prescribers? ❑No

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 ANTIMICROBIAL STEWARDSHIP PROGRAMMES IN HOSPITALS
SESSION THREE: INTERACTIVE WORKSHOP SESSIONS

CHECKLIST FOR CORE ELEMENTS OF HOSPITAL ANTIMICROBIAL STEWARDSHIP PROGRAMMES & CORE MEMMBERS OF MULTIDISCIPLINARY ANTIMICROBIAL STEWARDSHIP TEAMS
WHAT NEXT - SPECIFIC INTERVENTIONS TO IMPROVE ANTIMICROBIAL USE
Has a current antibiogram been distributed to ❑Yes
prescribers at your facility? ❑No

Do prescribers ever receive direct, personalized

communication about how they can improve their
antimicrobial prescribing?
❑Yes
❑No

jbmg
Acknowledgements: Information largely adapted from:
1. Antimicrobial Stewardship in Australian Hospitals (M Duguid& M Cruickshank, 2010)
[Available at http://www.safetyandquality.gov.au/wp-content/uploads/2012/02/Antimicrobial_stewardship_prelim_execsummary.pdf]
2. Safety and Quality Improvement Guide Standard 3: Preventing & Controlling Healthcare Associated Infections (Australian Commission on Quality and Safety in Health
Care, 2012) [Available athttp://www.safetyandquality.gov.au/wp-content/uploads/2012/10/Standard3_Oct_2012_WEB.pdf]
3. Antimicrobial Stewardship Teams & Committees Fact Sheet A component of the QUAH Antimicrobial Stewardship Toolkit © Clinical Excellence Commission 2013 Updated
December 2013 SHPN (CEC) 130488 [Available at http://www.cec.health.nsw.gov.au/__documents/programs/hai/quah/fact-sheet-ams-teams-and-committees.pdf]
4. CDC. Core Elements of Hospital Antibiotic Stewardship Programs. Atlanta, GA: US Department of Health and Human Services, CDC; 2014.
[Available at http://www.cdc.gov/getsmart/healthcare/ implementation/core-elements.html ]

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