sábado, 28 de junio de 2014

Core Elements Checklist | Implementation Resources | Get Smart for Healthcare | CDC

Core Elements Checklist | Implementation Resources | Get Smart for Healthcare | CDC



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 supportEstablished at facility
ADoes your facility have a formal, written statement of support from leadership that supports efforts to improve antibiotic use (antibiotic stewardship)?YesNo
BDoes your facility receive any budgeted financial support for antibiotic stewardship activities (e.g., support for salary, training, or IT support)?YesNo
Accountability 
AIs there a physician leader responsible for program outcomes of stewardship activities at your facility?YesNo
Drug Expertise 
AIs 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?
 
BCliniciansYesNo
CInfection Prevention and Healthcare EpidemiologyYesNo
DQuality Improvement  
EMicrobiology (Laboratory)YesNo
FInformation Technology (IT)YesNo
GNursingYesNo
Actions to support optimal antibiotic use 
PoliciesPolicy established
ADoes 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
BDoes 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 interventionsAction performed
CIs 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
DDo specified antibiotic agents need to be approved by a physician or pharmacist prior to dispensing (i.e., pre-authorization) at your facility?               YesNo
EDoes a physician or pharmacist review courses of therapy for specified antibiotic agents (i.e., prospective audit with feedback) at your facility?YesNo
Pharmacy-driven interventions
Are the following actions implemented in your facility?
Action performed
FAutomatic changes from intravenous to oral antibiotic therapy in appropriate situations?YesNo
GDose adjustments in cases of organ dysfunction?YesNo
HDose optimization (pharmacokinetics/pharmacodynamics) to optimize the treatment of organisms with reduced susceptibility?YesNo
IAutomatic alerts in situations where therapy might be unnecessarily duplicative?YesNo
JTime-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
KCommunity-acquired pneumoniaYesNo
LUrinary tract infectionYesNo
MSkin and soft tissue infectionsYesNo
NSurgical prophylaxisYesNo
OEmpiric treatment of Methicillin-resistant Staphylococcus aureus(MRSA)YesNo
PNon-C. Difficile infection (CDI) antibiotics in new cases of CDIYesNo
QCulture-proven invasive (e.g., blood stream) infectionsYesNo
Tracking: Monitoring antibiotic prescribing, use, and resistance 
Process measuresMeasure performed
ADoes your stewardship program monitor adherence to a documentation policy (dose, duration, and indication)?YesNo
BDoes your stewardship program monitor adherence to facility-specific treatment recommendations?YesNo
CDoes your stewardship program monitor compliance with one of more of the specific interventions in place?YesNo
Antibiotic use and outcome measuresMeasure performed
DDoes your facility track rates of C. difficile infection?YesNo
EDoes 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
FBy counts of antibiotic(s) administered to patients per day (Days of Therapy; DOT)?YesNo
GBy number of grams of antibiotics used (Defined Daily Dose, DDD)?YesNo
HBy direct expenditure for antibiotics (purchasing costs)?YesNo
Reporting information to staff on improving antibiotic use and resistance 
ADoes you stewardship program share facility-specific reports on antibiotic use with prescribers?YesNo
BHas a current antibiogram been distributed to prescribers at your facility?YesNo
CDo prescribers ever receive direct, personalized communication about how they can improve their antibiotic prescribing?YesNo
Education 
ADoes your stewardship program provide education to clinicians and other relevant staff on improving antibiotic prescribing? YesNo

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