Antimicrobial Stewardship Gap Analysis Tool
Appendix C: Antimicrobial Stewardship Gap Analysis ToolAntimicrobial Stewardship Gap Analysis ToolAntimicrobial StewardshipStrategiesAntimicrobial StewardshipStrategy AuditAction Step: Identify antimicrobial stewardship championsA physician serves asantimicrobial stewardship(AS) champion to supportfollowing clinical practiceguidelines for antimicrobialprescribing Yes; name and position:Nursing leadership serves asan AS champion to promotenursing assessment,documentation, andcommunication inantimicrobial stewardshipactivities Yes; name and position:A coordinator is assigned tooversee AS activities Yes; name and position:Senior leadership issupportive of AS activities Yes; name(s) and position(s): No (if checked, complete questions below)Barriers:Action Steps to Address Barriers: No (if checked, complete questions below)Barriers:Action Steps to Address Barriers: No (if checked, complete questions below)Barriers:Action Steps to Address Barriers:How is support demonstrated? No (if checked, complete questions below)Barriers:Action Steps to Address Barriers:Minnesota Antimicrobial Stewardship Program Toolkit for Long-term Care FacilitiesGuidance for Promoting Antimicrobial Stewardship in LTCF: Page 1www.health.state.mn.us
Action Step: Incorporate antimicrobial stewardship issues into a committee/workgroup(Antimicrobial Stewardship Team)A committee/workgroup(Antimicrobial Stewardship[AS] Team) is identified toincorporate AS issues Yes; AS Team formed Existingcommittee/workgroup:Identify committee membership: AS champion(s) Consulting or in-housepharmacist Nursing leadership Quality improvement AS Coordinator LTCF infection preventionist Senior leadership Information technologist Other: (e.g. members of collaborating hospital’s AS Team,microbiologyrepresentative): NoBarriers:AS Team develops andcommunicates roles andresponsibilities aboutantimicrobial stewardshipfor facility stakeholdersAction Steps to Address Barriers: Yes; describe: AS Team roles and responsibilities have been developed and aredocumented below:AS Team Member Name/Role:Responsibilities: AS Team roles and responsibilities are communicated to facilitystakeholders as described below: No (if checked, complete questions below)Barriers:Action Steps to Address Barriers:AS Team members havededicated time for ASactivities Yes; describe: No (if checked, complete questions below)Barriers:Action Steps to Address Barriers:The facility explores quality Yes; describe:improvement- and residentsafety-related grant funding No (if checked, complete questions below)opportunities that couldBarriers:Action Steps to Address Barriers:incorporate AS activitiesMinnesota Antimicrobial Stewardship Program Toolkit for Long-term Care FacilitiesGuidance for Promoting Antimicrobial Stewardship in LTCF: Page 2www.health.state.mn.us
AS Team regularly reviewsantimicrobial usesummaries/reports Yes; describe the review process, including the types ofsummaries/reports, and the frequency of review: NoBarriers:Action Steps to Address Barriers:The consulting or in-house Yes; name of pharmacist:pharmacist is engaged in ASRole: Consulting pharmacist In-house pharmacistactivities, particularlyantimicrobial measurement NoBarriers:Action Steps to Address Barriers:Nursing leadership/nursingchampion regularlycommunicates AS progressto nursing assistants andnurses Progress may includeimproved shift changehand-offs, compliancewith use of Situation–Background–Assessment– Request(SBAR) form, infectionrates, communicationand documentation ofnursing assessments, etc. Yes; describe the communication process, including the frequency ofcommunication:Medical director/physicianchampion regularlycommunicates AS progressto licensed providers in thefacility Consider communicatingaggregate and/orindividual antimicrobialuse results to providers Yes; describe the communication process, including the frequency ofcommunication:Medical director/physicianchampion communicatesaggregate and/or individualantimicrobial use results toproviders Yes; describe the communication process, including the regularity ofcommunication: NoBarriers: NoBarriers: NoBarriers:Action Steps to Address Barriers:Action Steps to Address Barriers:Action Steps to Address Barriers:Minnesota Antimicrobial Stewardship Program Toolkit for Long-term Care FacilitiesGuidance for Promoting Antimicrobial Stewardship in LTCF: Page 3www.health.state.mn.us
Published clinical practiceguidelines that support ASare reviewed by key ASstakeholders – at aminimum the medicaldirector/antimicrobialstewardship physicianchampion, nursingleadership/director ofnursing, infectionpreventionist, consulting/in-house pharmacist Yes; check all guidelines reviewed, and indicate by whom they arereviewed: Loeb M, Bentley DW, Bradley S, et al. Development of minimum criteriafor initiation of antibiotics in long-term care residents: Results of aconsensus conference. Infection Control and Hospital Epidemiology2001; 22:120-4. Medical director/AS physician champion Nursing leadership/director of nursing Infection preventionist Consulting/ in-house pharmacist Other, please specify: SHEA Position Paper. Nicolle LE, the SHEA Long-Term Care Committee.Urinary tract infections in long-term care facilities. Infection Control andHospital Epidemiology2001; 22:167-75. Medical director/AS physician champion Nursing leadership/director of nursing Infection preventionist Consulting/ in-house pharmacist Other, please specify: SHEA Position Paper. Strausbaugh LJ, Crossley KB, Nurse BA, et al.Antimicrobial resistance in long-term care facilities. Infection Control andHospital Epidemiology 1996; 17:129-40. Medical director/AS physician champion Nursing leadership/director of nursing Infection preventionist Consulting/ in-house pharmacist Other, please specify: SHEA Position Paper. Nicolle LE, Bentley D, Garibaldi R, et al.Antimicrobial use in long-term care facilities. Infection Control andHospital Epidemiology 1996; 17:119-28. Medical director/AS physician champion Nursing leadership/director of nursing Infection preventionist Consulting/ in-house pharmacist Other, please specify: IDSA Guidelines. High KP, Bradley SF, Gravenstein S, et al. Clinicalpractice guideline for the evaluation of fever and infection in olderadult residents of long-term care facilities: 2008 update by theInfectious Diseases Society of America. Clin Infect Dis 2009; 48:149-171.Available at:www.idsociety.org/Other Guidelines/#sthash.ntIBYQdM.IkHRSefX Medical director/AS physician champion Nursing leadership/director of nursing Infection preventionist Consulting/ in-house pharmacist Other, please specify:Minnesota Antimicrobial Stewardship Program Toolkit for Long-term Care FacilitiesGuidance for Promoting Antimicrobial Stewardship in LTCF: Page 4www.health.state.mn.us
Action Step: Provide education and training to nursing staff at all levels within the facility to promotethe timely and accurate recognition, assessment, communication, and documentation of change in aresident’s condition Other(s): Medical director/AS physician champion Nursing leadership/director of nursing Infection preventionist Consulting/ in-house pharmacist Other, please specify: No (if checked, complete questions below)Barriers:Action Steps to Address Barriers:Action Step: Provide regular antimicrobial stewardship education and training to all healthcarepersonnel, including providersProvide education and Yes; describe regularity of education and training, staff to whom it wastraining about AS toprovided, and topics included:resident care staff, includingprovidersConsider including findingsfrom AS assessments suchas: No Nursing and ProviderAntibiotic Use Attitudes Barriers:and Beliefs Surveys(Appendix D) Antimicrobial UseAssessment (Appendix E) Nursing ProcessEvaluation tool(Appendix F)Action Steps to Address Barriers:Minnesota Antimicrobial Stewardship Program Toolkit for Long-term Care FacilitiesGuidance for Promoting Antimicrobial Stewardship in LTCF: Page 5www.health.state.mn.us
Nursing staff at all levelswithin the facility utilizeeducation and training toolsto promote the timely andaccurate recognition,assessment, communication,and documentation ofchange in a resident’sconditionConsider the following toolsthat provide cues andorganize observations ofresident changes: Agency for HealthcareResearch and Quality(AHRQ) Improving PatientSafety in Long-Term CareFacilities:o Module 1. DetectingChange in a Resident'sConditiono Module 2.CommunicatingChange in a Resident'sCondition INTERACT Stop andWatch Early Warning Toolfor nursing assistants SBAR Form for licensednurses (Appendix G) AHRQ Concerned –Uncomfortable – Safety(CUS) CommunicationTool (Appendix H) AHRQ Changes thatMatter Tool (Appendix I) Yes; describe regularity of education and training, staff to whom it wasprovided, and topics included: NoBarriers:Action Steps to Address Barriers:Minnesota Antimicrobial Stewardship Program Toolkit for Long-term Care FacilitiesGuidance for Promoting Antimicrobial Stewardship in LTCF: Page 6www.health.state.mn.us
Action Step: Communicate antimicrobial stewardship messages to healthcare facility staff andresident family and visitorsCommunicate AS messagesto all facility staff (e.g., viastaff meetings, newsletters,etc.) Yes; describe:Communicate AS messagesto family/visitors (e.g., viabrochures, newsletters,family council meetings) Yes; describe: NoBarriers: NoBarriers:Action Steps to Address Barriers:Action Steps to Address Barriers:Action Step: Develop and communicate policies and protocols based on clinical guidelines forantimicrobial stewardship, infection management, and diagnostic testingFacility develops policiesbased on clinical practicestandards for AS (e.g., the 5Ds: right diagnosis, drug,dose, duration, and deescalation) Yes; describe:Facility develops policiesbased on clinical practiceguidelines for infectionmanagement includingprescribing algorithms andclinical pathways (e.g., Loebet al. [2001], SHEA/IDSAguidelines) Yes; describe: NoBarriers: NoBarriers:Facility develops Yes; describe:standardized policies andprotocols for ordering NoBarriers:diagnostic tests (e.g.,microbiology, imaging) basedon clinical guidelines (e.g.,High et al. [2008])Action Steps to Address Barriers:Action Steps to Address Barriers:Action Steps to Address Barriers:Minnesota Antimicrobial Stewardship Program Toolkit for Long-term Care FacilitiesGuidance for Promoting Antimicrobial Stewardship in LTCF: Page 7www.health.state.mn.us
Facility communicatespolicies and protocols forantimicrobial stewardship,infection management, anddiagnostic testing to alllicensed providers in thefacility Yes; describe: NoBarriers:Action Steps to Address Barriers:Action Step: Conduct surveillance for infectionsInfection surveillance is Yes; describe:conducted usingstandardized infectiondefinitions (e.g., Stone ND, etal. Surveillance definitions ofinfections in long-term carefacilities: revisiting theMcGeer criteria. InfectControl Hosp Epidemiol.2012;33:965-77.)Consider use of thefollowing: No Tips for Applying CDC’sBarriers:Infection SurveillanceGuidance (Appendix J) Infection SurveillanceDefinition Worksheet(Appendix K) Infection SurveillanceLinelist Template(Appendix L) Lee et al. (2007)Recommended practicesfor surveillance: APIC, Inc.Am J Infect Control2007;35:427-40.Infection preventionexpertise is available in theLTCFAction Steps to Address Barriers: Yes; describe: NoBarriers:Action Steps to Address Barriers:Minnesota Antimicrobial Stewardship Program Toolkit for Long-term Care FacilitiesGuidance for Promoting Antimicrobial Stewardship in LTCF: Page 8www.health.state.mn.us
Action Step: Evaluate the facility’s process to assess, communicate, and document a resident’s changein conditionThe facility performs process Yes; describe the process, including:mapping to examine keyDate of process mapping discussion:opportunities toFacilitator:communicate clinicalStaff participants:information pertinent toProcess mapping summary shared with:infections and antimicrobialstewardship NoConsider use of theBarriers:Action Steps to Address Barriers:following: Nursing ProcessEvaluation Tool,(Appendix F)Action Step: The facility sets the expectation that a change in a resident’s condition is consistentlycommunicated between nursing assistants and nursing through the use of a standardized processThe facility implements astandardized process tocommunicate a change in aresident’s condition fromnursing assistants (NAs) tonurses; use findings fromprocess mapping to developor revise processes Yes; describe the standardized communication process between NAsand nurses, including communication tools and staff education andtraining:Consider the followingresources to standardizecommunication: AHRQ Improving PatientSafety in Long-Term Care NoFacilities:Barriers: Concerned –Uncomfortable –Safety (CUS)Communication Tool(Appendix H) Changes that MatterTool (Appendix I) INTERACT Stop andWatch Early Warning Toolfor NAsAction Steps to Address Barriers:Minnesota Antimicrobial Stewardship Program Toolkit for Long-term Care FacilitiesGuidance for Promoting Antimicrobial Stewardship in LTCF: Page 9www.health.state.mn.us
Action Step: The facility sets the expectation that a change in a resident’s condition is consistentlycommunicated between nursing and providers through the use of a standardized processThe facility implements astandardized process tocommunicate a change inresident’s condition in aconsistent manner fromnursing to providers; usefindings from processmapping to develop or reviseprocesses Consider using Situation– Background –Assessment – Request(SBAR) Form (AppendixG) Yes; describe the standardized communication process betweennursing and providers, including communication tools and staff educationand training:The facility has identifiedsources of residentinformation (e.g., electronichealth record, 24-hour/dailyreport, shift changereport/communication,stand-up meetings, wallboards, etc.) Yes; describe:Type (verbal, written, electronic):The facility provideseducation and training tostaff on the standardizedcommunication process Yes; describe: NoBarriers:Action Steps to Address Barriers:Location of clinical documentation: NoBarriers: NoBarriers:Audit the implementation of Yes; describe:the standardizedcommunication process (e.g.,are nursing staff using Nostandardized communication Barriers:tools?)Action Steps to Address Barriers:Action Steps to Address Barriers:Action Steps to Address Barriers:Minnesota Antimicrobial Stewardship Program Toolkit for Long-term Care FacilitiesGuidance for Promoting Antimicrobial Stewardship in LTCF: Page 10www.health.state.mn.us
Audit the completeness and Yes; describe:accuracy of the informationincluded on the standardizedcommunication tool (e.g.,SBAR). For example, arenurses thoroughly and NoBarriers:appropriatelycommunicating theinformation requiredaccording to thestandardized communicationtool?Action Steps to Address Barriers:Action Step: The facility sets the expectation that a change in a resident’s condition is consistentlydocumentedCentrally document changein resident condition Yes; describe: NoBarriers:Action Steps to Address Barriers:The facility has integratedtools for informationgathering into the electronichealth record when possibleto provide consistency, carecontinuity, and centrallydocumented information(e.g., a UTI monitor) Yes; describe the tools and how they promote consistency, carecontinuity, an centrally-documented information:Information Technologysupport for AS activities isavailable to facilitateaccessibility of clinicaldocumentation; activitiesmay include reportgeneration, optimizingelectronic health record forclinical documentation, etc. Yes; describe: NoBarriers: NoBarriers:Action Steps to Address Barriers:Action Steps to Address Barriers:Minnesota Antimicrobial Stewardship Program Toolkit for Long-term Care FacilitiesGuidance for Promoting Antimicrobial Stewardship in LTCF: Page 11www.health.state.mn.us
Explore ways your electronic Yes; describe:health record vendor cansupport AS activities NoBarriers:Action Steps to Address Barriers:Action Step: Diagnostic testing results, including microbiology, are accessible in a timely manner forclinical decision-making and infection surveillanceA process is implemented to Yes; describe:ensure that diagnostictesting, includingmicrobiology results, are Noaccessible in a timely manner Barriers:for clinical decision-makingA process is implemented to Yes; describe:ensure that diagnostictesting, includingmicrobiology results, are Noaccessible in a timely manner Barriers:for infection surveillanceAction Steps to Address Barriers:Action Steps to Address Barriers:Action Step: All licensed providers in the facility follow clinical practice guidelines for infectionmanagementPolicies/protocols based on Yes; describe:clinical practice guidelinesfor the initiation ofantimicrobials (e.g., Loeb etal. [2001]) are followed by alllicensed providers in thefacility regardless of Noemployment status (e.g., full- Barriers:time, part-time or casualstatus; on-call; externalconsultant; etc.) Consider conductingantimicrobial useassessment to monitorguideline adherence(Appendix E)Action Steps to Address Barriers:Minnesota Antimicrobial Stewardship Program Toolkit for Long-term Care FacilitiesGuidance for Promoting Antimicrobial Stewardship in LTCF: Page 12www.health.state.mn.us
The facility ensures all Yes; describe:licensed providers followbasic antimicrobialstewardship practicesincluding the 5 Ds: rightdiagnosis, drug, dose,duration, de-escalation Consider engagingconsulting or in-housepharmacist Specifically ensure that allantimicrobial orders havethe following elements Nodocumented:Barriers:Diagnosis Treatment indication/rationale (e.g. specificresident symptomswarrantingantibiotics) Treatment site (e.g.urinary tract, lowerrespiratory tract, etc.)DrugDoseDuration Antibiotic start date Antibiotic end dateRoute/ de-escalationEmpirically prescribedantibiotics are reviewed bythe provider in a timelymanner and adjusted ordiscontinued based onmicrobiology culture andsensitivity resultsAction Steps to Address Barriers: Yes; describe the process, including:Who is notified of the results?Who is responsible for follow up? NoBarriers:Action Steps to Address Barriers:Minnesota Antimicrobial Stewardship Program Toolkit for Long-term Care FacilitiesGuidance for Promoting Antimicrobial Stewardship in LTCF: Page 13www.health.state.mn.us
All licensed providers in thefacility follow clinicalguidelines/recommendationsfor asymptomatic bacteriuriamanagement (e.g., InfectiousDiseases Society of America(IDSA) Guidelines for theDiagnosis and Treatment ofAsymptomatic Bacteriuria inAdults 2005.) Consider conductingantimicrobial useassessment to monitorguideline adherence(Appendix E) Yes; describe how the facility formalizes the use of IDSA clinicalguidelines:All licensed providers haveaccess to a local antibiogram;consider whether the dataare compiled from thefacility, local hospital,healthcare system, region,etc.; as well as how often thedata are updated (e.g.,annually, quarterly, monthly,etc.) Yes; describe 1) how antibiogram accessibility is achieved; 2) thesource of the antibiogram data; and 3) the frequency of antibiogramupdates: NoBarriers: NoBarriers:Action Steps to Address Barriers:Action Steps to Address Barriers:Action Step: Measure antimicrobial useThe facility establishes anantimicrobial utilizationbaseline Consider usingAntimicrobial UseAssessment (Appendix E) Yes; describe:By whom:Describe what is reviewed (e.g., data sourcesused): NoBarriers:Action Steps to Address Barriers:Minnesota Antimicrobial Stewardship Program Toolkit for Long-term Care FacilitiesGuidance for Promoting Antimicrobial Stewardship in LTCF: Page 14www.health.state.mn.us
The facility assessesantimicrobial use on aregular basis (e.g., monthly,quarterly, etc.) Yes; by whom:How often?Describe what is reviewed (e.g. data sources used):The facility assessesantimicrobialappropriateness on a regularbasis (e.g., monthly,quarterly, etc.); this activityis most suitable for theconsulting or in-housepharmacist. Assessprescribing trends byprovider and facility-wide Yes; by whom:Identify prescribing trends assessed:How often?Define published treatment guidelines used to determineappropriateness:The facility monitorscompliance with prescribingexpectations and clinicalpractice guidelines relevantto antimicrobial stewardship(e.g., monitor compliancewith Loeb minimum criteriafor initiation of antibiotics inLTC residents) Consider usingAntimicrobial UseAssessment (Appendix E) Yes; describe the process, including:By whom?How often?List facility practice expectations and/or clinical practice guidelines used:The facility developsantimicrobial usesummaries/reports on aregular basis Yes; describe:How often?List antimicrobial use summaries/reports: No (if checked, complete questions below)Barriers:Action Steps to Address Barriers: No (if checked, complete questions below)Barriers:Action Steps to Address Barriers: NoBarriers: NoBarriers:Action Steps to Address Barriers:Action Steps to Address Barriers:Minnesota Antimicrobial Stewardship Program Toolkit for Long-term Care FacilitiesGuidance for Promoting Antimicrobial Stewardship in LTCF: Page 15www.health.state.mn.us
List at least 2 long-term goals for antimicrobial stewardship at your facility1.2.List at least 4 short-term goals for antimicrobial stewardship at your facility1.2.3.4.List the 3 primary challenges / barriers to implementing / expanding antimicrobial stewardshipstrategies in your facility:1.2.3.Minnesota Antimicrobial Stewardship Program Toolkit for Long-term Care FacilitiesGuidance for Promoting Antimicrobial Stewardship in LTCF: Page 16www.health.state.mn.us
Barriers: Action Steps to Address Barriers: Senior leadership is supportive of AS activities Yes; name(s) and position(s): _ How is support demonstrated? No (if checked, complete questions below) Barriers: Action Steps to Address Barriers: Appendix C:
Chapter 5: Antimicrobial stewardship education for clinicians 123 Acronyms and abbreviations 126 5.1 Introduction 127 5.2 Key elements of antimicrobial stewardship education 128 5.2.1 Audiences 128 5.2.2 Principles of education on antimicrobial stewardship 129 5.2.3 Antimicrobial stewardship competencies and standards 129
A Hospital Pharmacist’s Guide to Antimicrobial Stewardship Programs Greater New York Hospital Association United Hospital Fund — Antimicrobial Stewardship Toolkit - Best Practices from the GNYHA/UHF Antimicrobial Stewardship Collaborative National Quality Pa
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Feb 24, 2021 · ix Fig. 1. Steps in clinical decision-making Examples of how to use the practical guide are: z as a reference when planning to implement an antimicrobial stewardship intervention; and z as a tool for educating colleagues and clinicians at your institution about antimicrobial stewardship. Barriers to a
health pharmacists-driven recommendation acceptance rates. 2. Provide examples of metrics to determine the success of an antimicrobial stewardship program. 3. Explain how order sets can be helpful in an antimicrobial stewardship program. Presented at the Washington State Hospital Associat
Aquatic Animal Species —Appendix G. Ohio land stewardship areas in GAP conservation status category 1 and 2. Appendix G. Ohio land stewardship areas in GAP conservation status category 1 and 2 . GAP status source refers to the means by which the
Antimicrobials, Aspergillus fumigatus, Antimicrobial Peptides 1. Introduction 1.1. Antimicrobial Peptides and Proteins It is notable that antimicrobial peptides particularly cationic ones play a signifi-cant role within the natural immunity of animal defences against topical and general microbes altogether species of life. These antimicrobial .
Antimicrobial Peptides 2 ANTIMICROBIAL PEPTIDES OFFERED BY BACHEM Ribosomally synthesized antimicrobial peptides (AMPs) constitute a structurally diverse group of molecules found virtually in all organisms. Most antimicrobial peptides contain less than 100 amino acid residues, have a net positive charge, and are membrane active. They are major
