Checklist for Core Elements of Hospital Antibiotic Stewardship Programs

T he 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 support	Established at facility
Does your facility have a formal, written statement of support from leadership that supports efforts to improve antibiotic use (antibiotic stewardship)?	Yes	No
Does your facility receive any budgeted financial support for antibiotic stewardship activities (e.g., support for salary, training, or IT support)?	Yes	No

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

Drug Expertise	Established at facility
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?	Established at facility
Clinicians	Yes	No
Infection Prevention and Healthcare Epidemiology	Yes	No
Quality Improvement
Microbiology (Laboratory)	Yes	No
Information Technology (IT)	Yes	No
Nursing	Yes	No

Actions to support optimal antibiotic use

Policies	Policy 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?	Yes	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?	Yes	No

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)?	Yes	No
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
Does a physician or pharmacist review courses of therapy for specified antibiotic agents (i.e., prospective audit with feedback) at your facility?	Yes	No

Top of Page

Pharmacy-driven interventions

Are the following actions implemented in your facility?	Action performed
Automatic changes from intravenous to oral antibiotic therapy in appropriate situations?	Yes	No
Dose adjustments in cases of organ dysfunction?	Yes	No
Dose optimization (pharmacokinetics/pharmacodynamics) to optimize the treatment of organisms with reduced susceptibility?	Yes	No
Automatic alerts in situations where therapy might be unnecessarily duplicative?	Yes	No
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
Community-acquired pneumonia	Yes	No
Urinary tract infection	Yes	No
Skin and soft tissue infections	Yes	No
Surgical prophylaxis	Yes	No
Empiric treatment of Methicillin-resistant Staphylococcus aureus (MRSA)	Yes	No
Non-C. Difficile infection (CDI) antibiotics in new cases of CDI	Yes	No
Culture-proven invasive (e.g., blood stream) infections	Yes	No

Top of Page

Tracking: Monitoring antibiotic prescribing, use, and resistance

Process measures	Measure performed
Does your stewardship program monitor adherence to a documentation policy (dose, duration, and indication)?	Yes	No
Does your stewardship program monitor adherence to facility-specific treatment recommendations?	Yes	No
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
Does your facility track rates of C. difficile infection?	Yes	No
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
By counts of antibiotic(s) administered to patients per day (Days of Therapy; DOT)?	Yes	No
By number of grams of antibiotics used (Defined Daily Dose, DDD)?	Yes	No
By direct expenditure for antibiotics (purchasing costs)?	Yes	No

Reporting information to staff on improving antibiotic use and resistance	Measure performed
Does you stewardship program share facility-specific reports on antibiotic use with prescribers?	Yes	No
Has a current antibiogram been distributed to prescribers at your facility?	Yes	No
Do prescribers ever receive direct, personalized communication about how they can improve their antibiotic prescribing?	Yes	No