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[CNISP] Acute-Care Hospital Antibiotic Stewardship Program Survey COPY 2

This survey aims to describe the status, strategies and process indicators of Antimicrobial Stewardship Programs (ASPs) across acute-care hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP). ASPs are a coordinated hospital program that promote the appropriate use of antimicrobials by healthcare professionals to reduce the emergence of resistance. They involve appropriate selection, dosing, route and duration of antimicrobial therapy, which help preserve the future effectiveness of antimicrobials by reducing their misuse and overuse (1).There are a wide variety of techniques that can be implemented in ASPs and studies on their effectiveness vary as well (1–5). For example, a prospective cluster-randomized trial showed that the technique of prospective audit and feedback was effective in reducing antibiotic use within adult inpatient populations (364.9 days per 1000 patient days in intervention group vs 384.2 days per 1000 patient days in control group) (2). Both the World Health Organization and Public Health Agency of Canada have emphasized antimicrobial stewardship in their action plans to combat AMR (6,7).

 

This survey was adapted from the Centers for Disease Control and Prevention’s Core Elements of Hospital Antibiotic Stewardship Programs Assessment Tool and a published survey from the Netherlands (8,9) . It should take approximately 30 minutes to complete. Please complete one survey per hospital. Responses to this survey should reflect hospital-level policies.

 

If you have any questions, please contact us via email at: cnisp-pcsin@phac-aspc.gc.ca.

 

1.    Core Elements of Hospital Antibiotic Stewardship Programs | Antibiotic Use | CDC [Internet]. [cited 2024 Jan 2]. Available from: https://www.cdc.gov/antibiotic-use/core-elements/hospital.html
2.    Chen JZ, Hoang HL, Yaskina M, Kabbani D, Doucette KE, Smith SW, et al. Efficacy and safety of antimicrobial stewardship prospective audit and feedback in patients hospitalised with COVID-19 (COVASP): a pragmatic, cluster-randomised, non-inferiority trial. Lancet Infect Dis [Internet]. 2023 Jun 1 [cited 2024 Jan 2];23(6):673. Available from: /pmc/articles/PMC9977404/
3.    Molina J, Peñalva G, Gil-Navarro M V., Praena J, Lepe JA, Pérez-Moreno MA, et al. Long-Term Impact of an Educational Antimicrobial Stewardship Program on Hospital-Acquired Candidemia and Multidrug-Resistant Bloodstream Infections: A Quasi-Experimental Study of Interrupted Time-Series Analysis. Clinical Infectious Diseases. 2017 Dec 15;65(12):1992–9. 
4.    Lawes T, Lopez-Lozano JM, Nebot CA, Macartney G, Subbarao-Sharma R, Dare CRJ, et al. Effects of national antibiotic stewardship and infection control strategies on hospital-associated and community-associated meticillin-resistant Staphylococcus aureus infections across a region of Scotland: a non-linear time-series study. Lancet Infect Dis [Internet]. 2015 Dec 1 [cited 2024 Jan 2];15(12):1438–49. Available from: https://pubmed.ncbi.nlm.nih.gov/26411518/
5.    Zay Ya K, Win PTN, Bielicki J, Lambiris M, Fink G. Association Between Antimicrobial Stewardship Programs and Antibiotic Use Globally: A Systematic Review and Meta-Analysis. JAMA Netw Open [Internet]. 2023 Feb 9 [cited 2024 Jan 2];6(2):E2253806. Available from: https://pubmed.ncbi.nlm.nih.gov/36757700/
6.    Public Health Agency of Canada. Pan-Canadian Action Plan on Antimicrobial Resistance [Internet]. [cited 2024 Jan 2]. Available from: https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/drugs-health-products/pan-canadian-action-plan-antimicrobial-resistance/pan-canadian-action-plan-antimicrobial-resistance.pdf
7.    WHO Library Cataloguing-in-Publication Data Global Action Plan on Antimicrobial Resistance [Internet]. 2015. Available from: www.paprika-annecy.com
8.    Kallen MC, Ten Oever J, Prins JM, Kullberg BJ, Schouten JA, Hulscher MEJL. A survey on antimicrobial stewardship prerequisites, objectives and improvement strategies: Systematic development and nationwide assessment in Dutch acute care hospitals. Journal of Antimicrobial Chemotherapy. 2018 Dec 1;73(12):3496–504. 
9.    The Core Elements of Hospital Antibiotic Stewardship Programs ANTIBIOTIC STEWARDSHIP PROGRAM ASSESSMENT TOOL. 

There are 45 questions in this survey.
General
(This question is mandatory)
Do you have a formal Antimicrobial Stewardship Program (ASP) for this hospital?
Team Composition
(This question is mandatory)
What year was your ASP formalized?
(This question is mandatory)
Provide the number of ASP-associated FTE pharmacists:
(This question is mandatory)

Please specify who is on the ASP team/committee:

(This question is mandatory)
If there is a pharmacist on the ASP team/committee, do they have formal antimicrobial stewardship training? 
Hospital Leadership Commitment and Accountability, and Resources
(This question is mandatory)
Does hospital leadership provide stewardship program lead pharmacist(s) dedicated time to manage the program and conduct daily stewardship interventions?
Does hospital leadership provide stewardship program lead MD(s) dedicated time to manage the program and conduct daily stewardship interventions?
Does hospital leadership provide stewardship program leader(s) with IT support to effectively operate the program?
Do you have clerical support for your program (secretary, administrative technician)?
Does the Hospital Board of Directors provide a budget for the ASP?
Do stewardship program leader(s) have regularly scheduled meetings with facility leadership and/or the hospital board to report and discuss stewardship activities, resources, and outcomes? 
Action: Implementation of Interventions
Does your facility perform prospective audit and feedback for specific antibiotic agents?

Does your facility perform preauthorization for specific antibiotic agents?

Preauthorization refers to prescribing restricted agents only after authorisation.

Does your facility have facility-specific treatment guidelines to assist with antibiotic selection for common clinical conditions?
Does your facility have a local antibiogram for susceptibilities of pathogens to assist with antibiotic selection for common clinical conditions?
(This question is mandatory)
Has your hospital implemented standardized criteria for: Switch from intravenous to oral antibiotic therapy 
(This question is mandatory)
Has your hospital implemented standardized criteria for: Streamlining / de-escalation of empirical antibiotic therapy 
(This question is mandatory)
Has your hospital implemented standardized criteria for: Dose optimization (TDM)
(This question is mandatory)
Has your hospital implemented standardized criteria for: Discontinuation of antibiotic therapy 
(This question is mandatory)
Has your hospital implemented standardized criteria for: Automatic antibiotic prescription stops 
(This question is mandatory)
Has your hospital implemented standardized criteria for: Surgical prophylaxis 
(This question is mandatory)

Does your hospital perform mandatory bedside consultations when prescribing restricted agents?

Tracking AMU and Outcomes
(This question is mandatory)
Do you currently have formal surveillance of quantitative antimicrobial use (AMU) for this hospital?
(This question is mandatory)

What year was your antimicrobial use surveillance program formalized?

 

(This question is mandatory)
Please specify what indicators your program uses:
(This question is mandatory)
Please specify the software quantitative use data is collected by:
(This question is mandatory)
Does your antibiotic stewardship program track antibiotic use by submitting AMU data to CNISP?
(This question is mandatory)
If no.... why not?
(This question is mandatory)
Do you find CNISP's AMU site-specific reports useful?
(This question is mandatory)
Do you use CNISP's AMU site-specific reports to guide and/or implement ASP interventions?
(This question is mandatory)
Does your antibiotic stewardship program share CNISP's site specific reports on AMU with prescribers?
(This question is mandatory)

How does your hospital monitor the use of restricted antibiotic agents?

Restricted antibiotic use may be limited to certain indications, prescribers, services, patient populations, or combinations thereof

(This question is mandatory)

Does your hospital check whether diagnostic tests were performed when prescribing restricted agents?

Restricted antibiotic use may be limited to certain indications, prescribers, services, patient populations, or combinations thereof

(This question is mandatory)
Does your facility have a policy that requires prescribers to document in the medical record or during order entry a fixed dose of antibiotic?
(This question is mandatory)
Does your facility have a policy that requires prescribers to document in the medical record or during order entry a fixed duration of antibiotic?
(This question is mandatory)
Does your facility have a policy that requires prescribers to document in the medical records or during order entry the number of days?
(This question is mandatory)
Does your facility have a policy that requires prescribers to document in the medical record or during order entry the indication for all antibiotic prescriptions?
(This question is mandatory)
Does your antibiotic stewardship program monitor prospective audit and feedback interventions by tracking the types of interventions and acceptance of recommendations?
(This question is mandatory)
Does your antibiotic stewardship program monitor pre-authorization interventions by tracking which agents are being requested for which conditions?
Reporting AMU and Outcomes
(This question is mandatory)

Does your stewardship program monitor adherence to facility-specific treatment recommendations?

(This question is mandatory)
Is an annual antibiogram (cumulative antibiotic susceptibility report) produced for this hospital?
(This question is mandatory)
Do you participate in CNISP antibiogram surveillance?
(This question is mandatory)
Has your facility distributed a current antibiogram (i.e. for the 2023 calendar year) to prescribers?
Education
Does your stewardship program provide education to prescribers and other relevant staff on optimal prescribing, adverse reactions from antibiotics, and antibiotic resistance?
Does your stewardship program provide education to prescribers as part of the prospective audit and feedback process (sometimes called "handshake stewardship")?
 
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