Antimicrobial Stewardship (AMS): a survey for Victorian hospitals

The following survey aims to explore hospital activities relating to AMS in Victorian hospitals. Information provided in the survey will facilitate a gap analysis and guide the development of state and national AMS strategies.

For further information on AMS, refer to "Antimicrobial Stewardship in Australian Hospitals 2011", edited by M Duguid and M Cruickshank, Australian Commission on Safety and Quality in Health Care, Sydney. Available online at

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Your Details

Name of health service /
Hospital campus (if applicable) /
Name of person completing survey /
Contact phone number /
Email address /

Hospital Demographics

1) Describe your hospital / Public Private Other
2) Hospital location / Metropolitan Regional Rural

3) Number of acute care beds 4) Number of sub-acute care beds

5) Do you have any of the following specialties at your hospital?

Cardiothoracics / Haematology/Oncology / Haemodialysis / Neurosurgery
Obstetrics & Gynaecology / Paediatrics / Transplant / None of these
6) Does your hospital have an intensive care unit (ICU)? / Yes No

If yes, how many beds?

7) Does your hospital have a high dependency unit (HDU)? / Yes No

If yes, how many beds?

8) Do you have access to the following resources?

Infectious diseases consultant / Infectious diseases registrar
Clinical microbiologist / Clinical microbiology registrar
Infectious diseases/antimicrobial specialist pharmacist / Quality use of medicines/Drug usage evaluation pharmacist
Infection control practitioner / None of these

Guidelines and Education

9) The Therapeutic Guidelines: Antibiotic, version 14, 2010, is available at your hospital as:
paper-based copies on ward intranet access not available
Comment

10) How are antimicrobial prescribing guidelines promoted?

Specifically mentioned in hospital antimicrobial policy / Yes No NOT APPLICABLE
Specifically discussed in orientation program for all new clinical staff / Yes No
Part of routine clinical activities / Yes No

Other, please specify

11) Does your hospital conduct in-house education on best practice in antimicrobial prescribing and antimicrobial resistance with:

Senior medical staff / Junior medical staff
Pharmacy / Nursing
Other / None of these (no education provided)

Specify 'other'

Antimicrobial Prescribing Policy, Formulary and Approval System

12) Does your hospital have an antimicrobial prescribing policy? / Yes No

13) In which year was it last reviewed?

14) Does your hospital have a formulary that covers antimicrobials? / Yes No
15) If yes, does it specify restrictions on the use of broad-spectrum antimicrobials? / Yes No NOT APPLICABLE

16) If yes, is there an approval system for these restricted antimicrobials?

Yes - an electronic approval system / Yes - a phone-based system
Yes - a fax-based system / Other - please specify below
NOT APPLICABLE

Describe 'other' approval system

17) Who has authority to provide approval for restricted antimicrobials?

In-house infectious diseases (ID) clinicians / In-house clinical microbiologists
Off-site ID clinicians / Off-site clinical microbiologists
Consultant physicians (non-ID) / Senior pharmacists
Other - specify below / NOT APPLICABLE

Specify other

18) For those with off-site arrangements for receiving antimicrobial prescribing advice/approval, are these arrangements:

Contracted - remunerated (specific agreement for provision of specialist service exists)
Contracted - as part of hospital network
Informal - a single nominated hospital is usually contacted but no formal agreement exists
Ad hoc - no specific site - advice could be sought from several possible hospitals
Other please specify
NOT APPLICABLE - no off-site arrangements necessary/ none in place

Specify 'other' off-site arrangements

Post Prescription Review

19) Does your hospital have an antimicrobial management team (AMT, dedicated multidisciplinary team involving at least one pharmacist and one medically trained staff member)?
Yes No

20) Are antimicrobial prescriptions regularly reviewed with point of care intervention and direct feedback to prescribers?
Always Mostly Occasionally Never

21) If reviewed, where does this occur?

Intensive Care Unit
General wards
Specialised units (e.g. haematology/transplant)
NOT APPLICABLE

22) If reviewed, who performs this review?

Antimicrobial management team / Infectious diseases specialist
Clinical microbiologist / Specialised antimicrobial pharmacist
Ward pharmacist / Infection control practitioner
Other please specify / NOT APPLICABLE

Specify 'other' reviewer

23) If reviewed, following the review is individual feedback provided to the prescriber?

Yes
No
NOT APPLICABLE

24) If yes, does the individual feedback involve review of the following?

Empiric choice of antimicrobial drug
Dose optimisation
De-escalation (use of narrower spectrum antibiotics where possible based on micro results)
Intravenous to oral switch
NOT APPLICABLE

Auditing

25) Does your hospital conduct regular audits of antimicrobial prescribing?
Yes No

26) If yes, please nominate methods used:

Antimicrobial cost
Antimicrobial consumption
Adherence to formulary restriction
Appropriateness of prescribing
Dedicated audits of specific drugs
Dedicated audits of specific clinical conditions
Dedicated audits of specific units/wards
Use of quality use of medicines indicators
Other
NOT APPLICABLE

Specify 'other' audit methods

27) Does your hospital provide regular feedback to prescribers about the outcomes of audits on antimicrobial prescribing practices?
Yes No

28) If yes, how is feedback given?

Email/letters to heads of units
Email/letters to individual prescribers
Presentations at ward or unit meetings
Presentations at grand rounds and/or quality committee meetings
Other please specify
NOT APPLICABLE

Specify 'other' types of feedback

Microbiology

29) Does your hospital's microbiology service selectively report antimicrobial sensitivities?
Yes No Don't know

30) Does your hospital's microbiology service provide antibiograms (summaries of the sensitivity patterns of local bacteria in your institution over time)?
Yes No Don't know

Resources

31) Does your hospital have a Quality Use of Medicines/Drug Usage Evaluation pharmacist?
Yes No

32) Is there dedicated funding for an antimicrobial stewardship pharmacist?
Yes No

33) Is there dedicated funding for medical staff to oversee antimicrobial stewardship?
Yes No

Governance

34) Does your hospital have a dedicated committee to oversee antimicrobial stewardship?
Yes No

35) If yes, who does this committee have lines of accountability to?

Drug and Therapeutics Committee
Clinical Governance Committee
Medication Safety Commitee
Quality & Risk Management Committee
Infection Prevention Committee
Executive Office
Other please specify
NOT APPLICABLE

Specify 'other'

Barriers

36) Which of the following barriers to AMS have you encountered at your hospital?

Lack of training and education in antimicrobial use provided to clinicians
Lack of leadership to promote AMS at the hospital
Lack of support from senior clinicians at the hospital
Lack of ID/micro services
Lack of pharmacy resources
Lack of willingness from doctors to change their prescribing practices
Lack of enforcement by hospital management
High level of transient/seconded staff
Other please specify

Specify 'other' barriers

Comments

37) If an AMS program is present in your hospital, how could it be improved?

38) If an AMS program is absent in your hospital, what is preventing one from being initiated?

Thank you for your assistance in completing the AMS survey.

This survey was developed by the Victorian Department of Health in conjunction with the National Health and Medical Research Council (NHMRC) funded initiative “Antimicrobial Stewardship: Establishing effective programs for Australian hospitals”.