Antimicrobial Stewardship Rounds Template & Audit Form

Welcome

This toolkit helps stewardship teams run consistent, efficient, and actionable antimicrobial stewardship (AMS) rounds. It includes a compact case-review checklist you can use at the bedside or at the workstation, data cues to focus daily and weekly reviews, short intervention templates clinicians can adopt verbatim, suggested EHR documentation text, and a monthly outcomes pack to track impact. Use this as a starting point and adapt fields, cadence, and roles to your local workflows and EHR.

Who this is for

Pharmacists, infectious disease clinicians, stewardship leads, hospitalists, infection preventionists, and quality teams who want a repeatable rounds process that identifies inappropriate antimicrobial use, documents recommendations, and supports measurement.

How to run stewardship rounds (compact workflow)

1. Prep (15–30 minutes): pull short list of patients with high-priority triggers (e.g., new broad-spectrum agents, prolonged therapy, positive cultures, IV agents beyond 48–72h, high-cost agents, or alerts from decision support).
2. Round team: stewardship pharmacist, ID physician (if available), clinical pharmacist/ward pharmacist, bed manager or nurse as needed.
3. Case review (3–7 minutes/patient): use the case-review checklist below. Prioritize patients where action is most likely to improve safety, de-escalate therapy, or reduce IV use/cost.
4. Document intervention: use short recommendation templates in the chart and record acceptance or reason for decline.
5. Follow-up: schedule a follow-up review if the team accepts a deferred plan (e.g., culture-based de-escalation pending results).

Case-review checklist (use at bedside or on-screen)

• Indication: Is there a documented, evidence-based indication for the antibiotic? (Yes / No / Unclear)
• Culture data: Have relevant cultures been obtained? Are results available to guide therapy?
• Antibiotic selection: Is spectrum appropriate for the organism/site? Can therapy be narrowed?
• Duration: Is duration compliant with local guidance? Can therapy be shortened?
• Dosing: Is dose adjusted for renal/hepatic function and PK/PD? Therapeutic drug monitoring needed?
• IV-to-oral (IV→PO): Is the patient clinically stable and able to take oral agents? Consider IV→PO conversion checklist (see below).
• Allergies/interactions: Any documented allergy or significant drug interactions?
• Optimization opportunity: Stop, de-escalate, narrow, switch route, dose optimize, or change agent for cost/safety reasons?
• Recommendation recorded: Documented recommendation and acceptance status (accepted / modified / declined).

IV-to-oral conversion checklist (practical rules of thumb)

• Clinical improvement for sepsis/respiratory/UTI sources (afebrile 24–48h, hemodynamically stable)
• Functioning GI tract and can tolerate oral meds
• Reliable absorption for the agent (check local equivalence)
• No ongoing need for IV-only agents (e.g., prolonged high-level bacteremia, certain deep-seated infections unless specialist-directed)

Daily and weekly data cues (pull these automatically if possible)

Daily cues

• Patients on broad-spectrum Gram-negative agents (e.g., carbapenems, piperacillin-tazobactam)
• Newly started agents within last 48–72 hours
• IV agents beyond 48–72 hours without documented plan
• Patients with positive culture results requiring therapy review
• High-cost or restricted antimicrobials started without approval

Weekly cues

• Days of therapy (DOT) by service and by agent
• IV-to-oral conversion rates
• C. difficile rates and recent exposures to high-risk agents
• Rates of broad-spectrum use (per 1,000 patient-days)
• Acceptance rate of stewardship recommendations

Sample stewardship recommendation language

Keep recommendations brief, specific, and actionable. Document the suggested change, the rationale, and any follow-up plan.

• Stop/Discontinue: "Recommend discontinuing ceftriaxone—no evidence of bacterial infection after 48h observation; continue supportive care. If culture positive, re-evaluate."
• De-escalate/Narrow: "Recommend narrowing from piperacillin–tazobactam to ceftriaxone based on culture sensitivity (E. coli susceptible) to reduce broad-spectrum exposure."
• IV→PO: "Recommend switch to oral levofloxacin 500 mg once daily given clinical improvement, afebrile >24h, tolerating oral meds."
• Dose optimization: "Recommend renal dose adjustment of vancomycin to X mg qY per current CrCl; recommend trough/level monitoring."

Suggested EHR documentation templates (copy/paste ready)

Use a short progress-note style entry that becomes part of the medical record and stewardship audit trail.

Stewardship note: Reviewed antimicrobial therapy for [patient name / MRN]. Current agent(s): [agent(s)]. Indication: [documented indication]. Recommendation: [stop / narrow / change / IV→PO / dose adjust]. Rationale: [brief reason]. Acceptance: [accepted / deferred / declined]. Follow-up planned: [date or condition]. Signed: [Stewardship pharmacist/ID physician].

Audit form (suggested fields — recommended for interactive capture)

These fields form a minimal audit record that teams can capture during rounds. Capturing structured responses enables measurement and reporting.

• Review Date
• Reviewer Name and Role
• Patient MRN / Unit
• Agent(s) Reviewed
• Reason for therapy (select or free text)
• Action recommended (stop / de-escalate / narrow / IV→PO / dose adjust / other)
• Recommendation text (short)
• Acceptance (accepted / modified / declined)
• Time to follow-up (if deferred)
• Outcome note (filled later: accepted and implemented / not implemented / culture changed plan)

Tip: Render this as an interactive form so reviewers can submit audit data in real time and the system aggregates acceptance rates and trends.

Monthly outcomes pack (metrics to track)

• DOT per 1,000 patient-days (overall and by service)
• % IV→PO conversions within 48–72h when eligible
• Acceptance rate of stewardship recommendations
• C. difficile incidence (cases per 10,000 patient-days) and recent exposure patterns
• Use of targeted high-risk agents (days or courses)
• Time-to-de-escalation after culture results

Provide simple visualizations: run chart of DOT, bar chart by service, table of top agents by DOT, and trend line for acceptance rate. Use these to surface opportunities at monthly stewardship meetings.

Implementation tips and common pitfalls

• Start small: pilot rounds on one service for 4–6 weeks, then expand.
• Make recommendations concise and easy to action — avoid long narrative.
• Track acceptance and learn why recommendations were declined to refine local guidance.
• Protect time for reviewers and pre-select cases to keep rounds efficient.
• Engage frontline clinicians with respectful language and data; celebrate quick wins.

How to tailor this toolkit

Localize: adapt indication lists, eligible IV→PO agents, duration standards, and dosing guidance to local antibiograms, formularies, and EHR education. Add restricted-agent approval workflows where needed.

Next steps and recommended platform enhancements

To make rounds data actionable at scale, consider:

• Rendering the Audit Form as an interactive form that stores submissions (acceptance, reason codes) for reporting.
• Automating daily cues from pharmacy/medication administration and microbiology feeds.
• Building dashboards for DOT, IV→PO conversion, and acceptance rate trends.

See Capability Enhancements below for concrete options.

Preserved existing material

This expanded toolkit retains the original elements: case-review template, recommended daily and weekly data cues (DOT, IV-to-oral opportunities), sample stewardship recommendations, documentation templates for the medical record, and a monthly outcomes pack to track DOT and C. difficile trends — now with structured fields, templates, and practical guidance for implementation and measurement.

Practical checklist (one-page)

1. Generate daily cue list (auto if possible).
2. Review each flagged case with the case-review checklist.
3. Make a single clear recommendation and document in the chart.
4. Record acceptance in the audit form.
5. Review monthly outcomes pack and adjust focus areas.

Resources & image

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