Antimicrobial Stewardship Rounds: Agenda & Case Review Template

Welcome — make every stewardship round purposeful

Use this playbook to run consistent, time-efficient antimicrobial stewardship rounds that reduce unnecessary antibiotic exposure, improve patient outcomes, and build clinician trust. The materials below include a reproducible agenda, the core data elements to gather before rounds, a practical case-review template, a step-by-step de-escalation checklist, recommended metrics to track, short communication scripts for prescribers, and tips to make rounds sustainable.

Why rounds matter

Stewardship rounds are where pharmacy, infectious disease (ID), and frontline clinicians align treatment decisions with diagnostic data and patient goals. When structured well, rounds: reduce broad-spectrum and prolonged therapy, increase targeted therapy, lower adverse events (including C. difficile), and create teachable moments that shift prescribing culture.

Suggested rounds agenda (45–60 minutes typical)

1. Pre-round prep (30–60 minutes before)
   • Pharmacy/ID compile list of patients to review with core data (see Core Data Elements).
   • Flag recent culture results, imaging, and antibiotic start dates.
2. Opening & prioritization (5 minutes)
   • Quickly prioritize patients by safety risk, duration on therapy, or potential for de-escalation.
3. Case reviews (30–40 minutes)
   • Review 6–12 cases depending on complexity. For each: present concise summary, recommendation, rationale, and next action.
4. Documentation & assignment (5–10 minutes)
   • Record accepted recommendations in chart and assign follow-up tasks (orders to change, labs to monitor, reassess date).
5. Education & quick debrief (5 minutes)
   • Share one short teaching point or local guideline reminder; record topics for future education.

Roles & suggested participants

• Stewardship pharmacist (lead for patient list and recommendations)
• ID physician (available for complex cases or high-risk patients)
• Ward/clinical nurse or unit representative (when helpful for execution details)
• Primary team clinician(s) or attending (invite for cases where decision authority is needed)

Core data elements to gather before or at case review

• Patient identifiers: name, MRN, location
• Antibiotic(s): drug, dose, route, start date/time
• Indication: documented working diagnosis or source of infection
• Relevant cultures and susceptibilities (date, organism, susceptibilities)
• Recent labs tied to infection (WBC trend, procalcitonin where used, CRP)
• Allergies and documented intolerance
• Renal/hepatic function affecting dosing
• IV-to-PO eligibility (intestinal function, oral absorption)
• Duration of therapy planned vs. best-evidence duration
• Presence of source control (drainage, device removal) and status
• Clinical trajectory (improving, stable, worsening)
• Previous antimicrobial exposures during admission or recent admissions

Case review template (use this script for each patient)

1. One-line patient summary: age, unit, key comorbidity.
2. Antibiotic summary: agent(s), start date, indication.
3. Microbiology & diagnostics: cultures, PCR, imaging; note actionable results.
4. Clinical status: vital signs, organ support, lab trends.
5. Assessment: likely infection vs. colonization, source controlled?
6. Recommendation: stop, narrow, continue, IV→PO, change dose, obtain cultures, or escalate to ID consult.
7. Rationale: one- or two-sentence evidence or safety reason.
8. Follow-up plan: who will implement, how to document, reassessment time/date.

De-escalation / decision checklist

Run down these items before making a recommendation to stop or narrow therapy:

• Is the current antibiotic clearly indicated? If not, consider stopping.
• Do culture results support narrowing to a targeted agent?
• Has the patient been clinically improving for 48–72 hours?
• Is source control achieved or planned?
• Can IV therapy be switched to oral (absorption and swallowing intact)?
• Is duration aligned with guideline-based duration for the syndrome?
• Are dose adjustments needed for renal or hepatic function?
• Are there drug–drug interactions or allergy risks to address?
• Have you documented the indication and planned duration in the chart?

Short, practical communication scripts

Use concise, trusted language that clinicians can act on quickly. Adapt to local tone.

• SBAR-style recommendation: "Situation: Mrs. X on piperacillin–tazobactam for suspected HAP. Background: cultures pending; improving clinically. Assessment: low probability of resistant pathogen. Recommendation: stop piperacillin–tazobactam and observe off antibiotics; we’ll re-evaluate in 24–48h. Agree?"
• Narrowing script: "Culture grew E. coli susceptible to cefazolin. Recommend change to cefazolin 2 g IV q8h or cefuroxime PO if able — narrower spectrum, same efficacy."
• IV→PO switch: "Patient tolerating PO, afebrile >24h, WBC improving. Recommend oral levofloxacin to complete course; will stop IV once first oral dose given."
• If prescriber resists: "I hear your concern about X. Based on the data, here’s the risk/benefit we see. If you prefer, we can document watchful waiting and reassess at [time]."

Recommended stewardship metrics

Track a balanced set of process, outcome, and acceptance measures. Aim for automated EHR pulls where possible.

• Process metrics
  • Percent of antibiotic orders with documented indication
  • Percent of reviewed patients with a documented stewardship recommendation
  • Time to de-escalation (median hours from culture or notification)
  • IV-to-PO conversion rate where appropriate
• Utilization metrics
  • Days of therapy (DOT) per 1,000 patient-days by antibiotic class
  • Antibiotic starts per 1,000 admissions
• Outcome and safety metrics
  • Hospital-onset C. difficile rates
  • 30-day readmission for infection-related causes
  • Acceptance rate of stewardship recommendations

Documentation & follow-up

• Document recommendations as an order or chart note and include rationale and reassessment time/date.
• Assign a specific clinician to implement changes (pharmacist may place an order if policy allows).
• Record acceptance or refusal with reason to track acceptance rates.

Tips to make rounds effective and sustainable

• Limit rounds to a manageable list; prioritize high-impact cases first.
• Keep each case presentation to 1–2 minutes using the case template.
• Build trust: start with collaborative, nonjudgmental language and cite data when possible.
• Use quick teaching moments rather than long lectures; collect topics for formal education.
• Measure and share outcomes regularly with frontline teams to show impact.

Common pitfalls to avoid

• Relying solely on culture growth without considering clinical context.
• Failing to document recommendations, which reduces accountability and follow-through.
• Overloading rounds with low-yield cases, which reduces attention for high-priority patients.

Next steps & local adaptation

Adapt the agenda, template, and scripts to your local workflows and EHR capabilities. Consider building a simple form in the EHR or using the platform's interactive form capability to collect case review outcomes and track metrics automatically.

Quick reference — one-page checklist

• Gather core data before rounds
• Prioritize cases by safety and de-escalation opportunity
• Use the case review template and de-escalation checklist
• Deliver a concise recommendation with rationale and follow-up
• Document recommendation and assign implementation
• Track acceptance and key metrics

Suggested resources

• Local antibiogram and facility treatment guidelines
• National guideline summaries (IDSA, SHEA)
• Sample IV-to-PO conversion criteria

Use this playbook as a living tool: collect feedback after a few rounds, iterate the agenda and templates to match your team’s pace, and track simple metrics that show value.