| Local Site Champions [25] |
• Individuals working at a site, known to
clinic staff, knowledgeable of local site logistics, and
willing to champion ASP efforts at their site.
(administrative staff, pharmacist, 1–2 physicians or nurse
practitioner depending on the site) |
| Clinic Work Flow Analyses [26] |
• Identifying stewardship opportunities in the
process of patient flow through each clinic from requesting
an appointment, the various staff encountered, their roles
in encounters suspected of being an infection, and different
places in the clinic (reception, office assistant or nursing
station, clinical exam room) the patient moved through |
| Audit and Feedback Reports [27,28] |
• Clinic records were audited every 3 months to
abstract antimicrobial prescribing information for every
respiratory and urinary tract infection (women only)
identified. 1-page reports detailed overall prescribing
rates compared to the other clinics, and antimicrobial
choices for the four targeted infections |
| Prescriber-focused E-learning modules [29] |
• A 2 hour set of 5 modules (introduction to
antimicrobial resistance and stewardship, and 1 for each of
the 4 infections) explaining the infection-specific use of
the decision aids, key communication points and patient
education aids |
| Prescribing Clinical Decision Aids [30–32] |
• 1-page decision support aids for prescribing
decisions, or guideline summaries, providing
infection-specific diagnostic criteria, indications for
antimicrobials, recommended antimicrobials, use of delayed
prescriptions, supportive care, and symptoms suggesting
serious complications |
| Communication Scripts [33,34] for
Patient Engagement |
• Education about antimicrobial-specific
communication skills, key stewardship points to communicate
to patient specific to each condition, and sample scripts of
ways to communicate points |
| Delayed Antimicrobial Prescriptions [35] |
• Suggested situations and instructions to
patients for delaying a prescribed antimicrobial |
| Safety Netting Messages [36] |
• Specific follow up advice to patients where
antimicrobials were not prescribed, to ensure any worsening
infections received medical care |
| Environmental Messaging, Patient Education
[15,19] |
• Patient handouts reinforcing stewardship
rationale, adverse antimicrobial effects, supportive care
and safety netting. Waiting room posters, videos of
stewardship information were used in some clinics |
