Purpose: To help assess which ASP elements are currently in place in terms of staff and strategies.
Source: Adapted from Greater New York Health Assocation/United Hospital Fund ASP Chapter 2, "The Antimicrobial Stewardship Core Team," and Chapter 3-B, "Core Strategies."
Instructions: Complete checklist, review responses to ascertain the level of leadership support, and target areas that need strengthening to move forward.
| Staff Resource | Check If Available: |
|---|---|
| Infectious disease–trained physician | ___ |
| Clinical pharmacist | ___ |
| Clinical microbiologist | ___ |
| Infection control representative | ___ |
| Hospital epidemiologist | ___ |
| Information technology | ___ |
| Strategies in place Prospective audit with intervention and feedback |
___ |
| Education | ___ |
| Guidelines and clinical pathways | ___ |
| Antimicrobial cycling | ___ |
| Antimicrobial order forms | ___ |
| Formulary restriction and preauthorization | ___ |
| Combination therapy | ___ |
| Streamlining or de-escalation of therapy | ___ |
| Dose optimization | ___ |
| Parenteral to oral conversion | ___ |
| Health care information technology | ___ |
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