Antibiotic Stewardship Sample Policies
Below is a collection of sample policies and procedures that facility administrators may use to effectively implement the Antibiotic Stewardship Program within their clinic or hospital. The available policies cover a wide breadth of topics, including:
- Sepsis management protocols
- Renal dosing program guidelines
- Antibiotic Stewardship infection control policies and tools
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Sample Antibiotic Stewardship Policy
A sample organization-wide antibiotic stewardship policy that includes measures of success.
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Sample 2 Antibiotic Stewardship Policy
A sample organization-wide antibiotic stewardship policy that incorporates a Physician Champion.
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Sample 3 Antibiotic Stewardship Policy
A sample organization-wide antibiotic stewardship policy.
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Medication Tracking Log
A sample tool that can be used to track the use of antibiotics in your organization.
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Antibiotic Soft Stop Order Notice
A tool that be placed on medical records to prompt the physician to either discontinue or reorder antibiotics after 14 days.
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Antibiotic Time Out
A sample policy for re-evaluating the need for continuation of an antibiotic.
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Extended Infusion Auto-substitution for Zosyn
A sample policy to guide pharmacy dosing of Zosyn.
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Guidance on Contract Language
Sample language that can be used in a contract with an Infectious Disease Physician to oversee Antibiotic Stewardship program.
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IV to PO Conversion Protocol
Sample IV to PO conversion protocol to facilitate transition of IV medications to oral.
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LIP Reassessment of Volume Status and Tissue Perfusion
Tool to facilitate the volume status and tissue perfusion reassessment 6 hours after a patient presents in septic shock.
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Renal Dosing Clarification Order
A sample renal dosing clarification order that can be used by pharmacist when adjusting doses per an approved dosing program.
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Pharmacy Rounding Form
Sample tool that can be used by pharmacist during patient rounds.
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Sample Physician Order set for Pneumonia
Sample physician order set for pneumonia. These orders are designed according to evidence-based practice and with antibiotic stewardship in mind.
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Sample Physician Order set for Pneumonia/Sepsis
Sample physician order set for pneumonia/sepsis. These orders are designed according to evidence-based practice and with antibiotic stewardship in mind.
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Sample Antibiotic Review Policy
A sample policy that describes the process of pharmacy review of organizational antibiotic use.
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Sample Policy for Protected Antimicrobials
Sample policy describing review of use of antimicrobials that are on the restricted use list.
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Renal Dosing Program
Sample policy that provides clinical directive for renal dose adjustments for adults based on the degree of renal impairment.
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Renal Dosing Protocol
Detailed sample protocol for renal adjustments on specific medications.
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Sample Sepsis Physician Order Set
Sample physician order set for sepsis. These orders are designed according to evidence-based practice and with antibiotic stewardship in mind.