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 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
Accountability
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
Education
A	Does your stewardship program provide education to clinicians and other relevant staff on improving antibiotic prescribing?	Yes	No