1. We, the administration, are committed to supporting efforts that improve antibiotic use in our facility.

2. We understand that antimicrobial stewardship is an interdisciplinary activity that improves the selection of an antibiotic therapy (correct drug, dose, duration and ordered only when necessary).

3. We will include antimicrobial stewardship-related duties in position descriptions for the medical director, clinical nurse leads, and consultant pharmacists.

4. We will provide dedicated and protected time for the facility’s infection preventionist to serve as a member of the facility’s AMS Leadership Team. He/she will work with the physician champion and pharmacist champion to implement the antimicrobial stewardship program. He/she will coordinate educational initiatives for staff on the risks and benefits of antibiotic use as well as improved nurse-prescriber communication for symptoms and diagnostic testing.

5. We will communicate with nursing staff and prescribing clinicians the facility’s expectations about use of antibiotics and the monitoring and enforcement of antimicrobial stewardship policies.

6. We will financially and educationally support a commitment to safe and appropriate antibiotic use in our facility (per proposed 2017 CMS recommendations) which currently states: “Requires an antibiotic stewardship program that includes antibiotic use protocols and a system for monitoring antibiotic use”

a. We will require practitioners to document in the medical record or during order entry an indication for all antibiotics, in addition to other required elements, such as dose and duration.

b. We will assist our prescribers, nurses, and our consultant pharmacists in developing antibiotic use protocols that ensure the appropriateness (drug, dose and duration of therapy) of any new antimicrobial agent ordered. We will attempt to reach out to clinicians with infectious diseases expertise in the hospital community (physicians and/or pharmacists) to develop these antibiotic use protocols.

c. We will reassess the use of antibiotics after they are initiated. One to two days after the initiation of antibiotic therapy, culture results will be available. The day that laboratory test (cultures) results become available, it shall be entered into the patient’s medical record and the action(s) taken in response to these results. Actions may include: discontinue antibiotics, continue antibiotics, or switch antibiotics.

d. We will work with our prescribers to create a system that monitors and shares reports regarding antibiotic use in the facility.

7. We commit to creating a culture, through messaging, education, and celebrating improvement, which promotes antimicrobial stewardship within our facility