antimicrobial stewardship programme. The composition of the (usually multidisciplinary) antimicrobial stewardship team is flexible and should be based on existing international recommendations and adapted to the local context. Newly suggested checklist item: Are clinicians, other than those part of the antimicrobial stewardship team (e.g. from the ICU, Internal Medicine and Surgery) involved in the antimicrobial stewardship committee? Selected by 13 experts. Checklist item 2.5: Is an annual report focused on antimicrobial stewardship (summary antimicrobial use and/or practices improvement initiatives, with short term and long-term goals for improving antimicrobial use) produced for your facility? Selected by 14 experts. Rephrasing suggested: Does the antimicrobial stewardship committee produce regularly [indicate minimum time] a dedicated report which includes e.g. antimicrobial use data and/or prescription improvement initiatives, with short term and long term measurable goals/targets for optimising antimicrobial use? Rephrasing selected by 11 experts: Does the antimicrobial stewardship committee produce regularly [indicate minimum time] a dedicated report which includes e.g. antimicrobial use data and/or prescription improvement initiatives, with time-committed short term and long term measurable goals/targets for optimising antimicrobial use? Checklist item 2.6: Is there a document clearly defining the procedures of collaboration of the antimicrobial stewardship team/committee with the infection prevention and control team/committee? Selected by 11 experts => Reassessed during the 2nd round Rephrasing suggested: Is a document clearly defining the terms of collaboration of the antimicrobial stewardship team/committee with the infection prevention and control team/committee? Selected by 12 experts, 7 of them opting for the initial item: Is there a document clearly defining the procedures of collaboration of the antimicrobial stewardship team/committee with the infection prevention and control team/committee?
CORE ELEMENT 3: DRUG AND INFECTION MANAGEMENT EXPERTISE Selected by 15 experts. Rephrasing suggested: Available expertise on infection management With an accompanying comment: This section relates to the expertise in diagnosing, treating and preventing infections (including antimicrobial prescribing) and in implementing an antimicrobial stewardship strategy. Rephrasing selected by 8 experts: Available expertise on infection management Checklist item 3.1: Do you have enough laboratory/imaging capacity to be able to diagnose the most common infections at your facility? Selected by 12 experts. Rephrasing suggested: Do you have access to laboratory/imaging services and to timely results to be able to support the diagnosis of the most common infections at your hospital? With an accompanying comment: A separate checklist on laboratory capacity and presence of quality assurance should be developed at national/international These services can be onsite or not. Rephrasing selected by 13 experts: Do you have access to laboratory/imaging services and to timely results to be able to support the diagnosis of the most common infections at your hospital? Checklist item 3.2: Are enough healthcare professionals (medical doctor, pharmacist, nurse...) adequately trained and experienced in infection management (diagnosis, prevention and treatment), antimicrobial prescribing and stewardship at your facility? (for them to constitute an antimicrobial stewardship team) Selected by 14 experts. Rephrasing suggested: In your hospital are there, or do you have access to, trained and experienced healthcare professionals (medical doctor, pharmacist, nurse...) in infection management (diagnosis, prevention and treatment) & stewardship willing to constitute an antimicrobial stewardship team? Rephrasing selected by 12 experts: In your hospital are there, or do you have access to, trained and experienced healthcare professionals (medical doctor, pharmacist, nurse...) in infection management (diagnosis, prevention and treatment) & stewardship willing to constitute an antimicrobial stewardship team?
CORE ELEMENT 4: EDUCATION Selected by 15 experts. Rephrasing suggested: Education & Practical training Rephrasing selected by 14 experts: Education & Practical training Checklist item 4.1: Does your stewardship programme provide education to clinicians and other relevant staff on improving antibiotic prescribing? Selected by 14 experts. Rephrasing suggested: Does your hospital offer a range of educational resources to support staff training on how to optimise antimicrobial prescribing? With an accompanying comment: resources can be developed locally or not, and can use multiple formats. Rephrasing selected by 11 experts: Does your hospital offer a range of educational resources to support staff training on how to optimise antimicrobial prescribing? Checklist item 4.2: Do the antimicrobial stewardship team members receive regular training in antimicrobial prescribing and stewardship? Selected by 12 experts. Rephrasing suggested: Have the antimicrobial stewardship team members received formal training in antimicrobial prescribing and stewardship? With an accompanying comment: This training is usually not offered at the hospital level, but likely to be at a regional, national or international level. The hospital should however ensure that members of the antimicrobial stewardship team are adequately trained, according to local/regional/national requirements. Initial item selected by 8 experts: Do the antimicrobial stewardship team members receive regular training in antimicrobial prescribing and stewardship? CORE ELEMENT 5: OTHER ACTIONS AIMING AT RESPONSIBLE ANTIMICROBIAL USE Selected by 14 experts. - Checklist item 5.1: Selected by 12 experts. -
Checklist item 6.3: Does your facility monitor antibiotic susceptibility rates for a range of common bacteria? Selected by 14 experts. Rephrasing suggested: Does your hospital monitor antibiotic susceptibility rates for a range of key bacteria? Rephrasing selected by 12 experts: Does your hospital monitor antibiotic susceptibility rates for a range of key bacteria? Checklist item 6.4: Does your facility monitor antibiotic use (consumption) at the unit and/or facility wide level? Selected by 14 experts. Rephrasing suggested: Does your hospital monitor the quantity of antimicrobials prescribed/ dispensed/purchased at the unit and/or hospital wide level? Rephrasing selected by 11 experts: Does your hospital monitor the quantity of antimicrobials prescribed/ dispensed/purchased at the unit and/or hospital wide level? CORE ELEMENT 7: REPORTING (on an ongoing basis) Selected by 15 experts. Rephrasing suggested: Reporting & Feedback (on a continuous basis) Rephrasing selected by 14 experts: Reporting & Feedback (on a continuous basis) Checklist item 7.1: Does your stewardship programme share facility-specific reports on antibiotic use (consumption) with prescribers? Selected by 14 experts. Rephrasing suggested: Does your stewardship programme share hospital-specific reports on the quantity of antimicrobials prescribed/dispensed/purchased with prescribers? With an accompanying comment: These reports should also be shared with the hospital management leadership. Rephrasing selected by 8 experts: Does your stewardship programme share hospital-specific reports on the quantity of antimicrobials prescribed/dispensed/purchased with prescribers? Checklist item 7.2: Does your stewardship programme share facility-specific reports on antibiotic susceptibility rates with prescribers? Selected by 14 experts. With an accompanying comment: These reports should also be shared with the hospital management leadership. - Checklist item 7.3: Selected by 14 experts. Rephrasing suggested: Are results of audits/reviews of the quality/appropriateness of Rephrasing selected by 12 experts: Are results of audits/reviews of the quality/appropriateness