| LEADERSHIP SUPPORT |
| Document | 82 (84.5%) | 93 (67.9%) | 0.006 | 78 (91.8%) | 67 (70.5%) | 30 (55.6%) | < 0.001 | 175 (74.8%) |
| Financial budget | 24 (24.7%) | 30 (21.9%) | 0.725 | 29 (34.1%) | 16 (16.8%) | 9 (16.7%) | 0.010 | 54 (23.1%) |
| ACCOUNTABILITY |
| Physician leader | 62 (63.9%) | 67 (48.9%) | 0.032 | 66 (77.7%) | 44 (46.3%) | 19 (35.2%) | < 0.001 | 129 (55.1%) |
| Pharmacist leader | 83 (85.6%) | 100 (73.0%) | 0.032 | 74 (87.1%) | 72 (75.8%) | 37 (68.5%) | 0.027 | 183 (78.2%) |
| Key support |
| Clinician | 94 (96.9%) | 115 (83.9%) | 0.032 | 82 (96.5%) | 85 (89.5%) | 42 (77.8%) | 0.032 | 209 (89.3%) |
| Pharmacist | 91 (93.8%) | 120 (87.6%) | 0.176 | 74 (87.1%) | 72 (75.8%) | 37 (68.5%) | 0.094 | 211 (90.2%) |
| ACTION TO SUPPORT OPTIMAL ANTIBIOTIC USE |
| Policies |
| Facility have a policy | 79 (81.4%) | 98 (71.5%) | 0.113 | 75 (88.2%) | 69 (72.6%) | 33 (61.1%) | 0.001 | 177 (75.6%) |
| Facility have facility- specific treatment recommendations | 74 (76.3%) | 93 (67.9%) | 0.210 | 71 (94.7%) | 66 (95.6%) | 30 (90.9%) | 0.027 | 167 (71.4%) |
| Broad interventions |
| Preauthorization for specific antibiotic agents | 85 (87.6%) | 108 (78.8%) | 0.117 | 76 (89.4%) | 83 (87.4%) | 34 (62.9%) | < 0.001 | 193 (82.5%) |
| Review courses of therapy for specified antibiotic agents | 83 (85.6%) | 117 (85.4%) | 1.000 | 75 (88.2%) | 85 (89.5% | 40 (74.1%) | 0.025 | 200 (85.5%) |
| Pharmacy-driven interventions |
| From IV to PO | 89 (91.8%) | 131 (95.6%) | 0.343 | 82 (96.5%) | 88 (92.6%) | 50 (92.6%) | 0.467 | 220 (94.0%) |
| Dose adjustments when organ dysfunction | 90 (92.8%) | 133 (97.1%) | 0.208 | 82 (96.5%) | 93 (97.9%) | 48 (88.9%) | 0.039 | 223 (95.3%) |
| Dose optimization | 79 (81.4%) | 94 (68.6%) | 0.040 | 66 (77.6%) | 71 (74.7%) | 36 (66.7%) | 0.347 | 173 (73.9%) |
| Automatic alerts when unnecessarily duplicative therapy | 49 (50.5%) | 79 (57.7%) | 0.343 | 52 (61.2%) | 46 (48.4%) | 30 (55.6%) | 0.227 | 128 (54.7%) |
| Diagnosis and infections specific interventions |
| Community-acquired pneumonia | 42 (43.3%) | 50 (36.5%) | 0.361 | 44 (51.8%) | 38 (40.0%) | 10 (18.5%) | < 0.001 | 92 (39.3%) |
| Urinary tract infection | 40 (41.2%) | 53 (38.7%) | 0.797 | 45 (52.9%) | 37 (38.9%) | 11 (20.4%) | 0.001 | 93 (39.7%) |
| Skin and soft tissue infections | 47 (48.5%) | 60 (43.8%) | 0.568 | 51 (60.0%) | 42 (44.2%) | 14 (25.9%) | < 0.001 | 107 (45.7%) |
| Surgical prophylaxis | 56 (57.7%) | 68 (49.6%) | 0.276 | 53 (62.4%) | 51 (53.7%) | 20 (37.0%) | 0.014 | 124 (53.0%) |
| Empiric treatment of Methicillin-resistant Staphylococcus aureus (MRSA) | 35 (36.1%) | 41 (29.9%) | 0.396 | 40(47.1%) | 21 (22.1%) | 15 (27.8%) | 0.001 | 76 (32.5%) |
| Culture-proven invasive (e.g. blood stream) infections | 41 (42.3%) | 50 (36.5%) | 0.450 | 46 (54.1%) | 32 (33.7%) | 13 (24.1%) | 0.001 | 91 (38.9%) |
| TRACKING: MONITORING ANTIBIOTIC PRESCRIBING, USE AND RESISTANCE |
| Process measures |
| Monitor adherence to stewardship policy | 79 (81.4%) | 107 (78.1%) | 0.646 | 67 (78.8%) | 77 (81.0%) | 42 (77.8%) | 0.936 | 186 (79.5%) |
| Monitor adherence to facility-specific treatment recommendations | 67 (69.1%) | 90 (65.7%) | 0.689 | 66 (77.6%) | 57 (60.0%) | 34 (62.9%) | 0.032 | 157 (67.1%) |
| Antibiotic use and outcome measures |
| Track rates of Clostridioides difficile infection | 28 (28.9%) | 27 (19.7%) | 0.141 | 29 (34.1%) | 13 (13.7%) | 13 (24.1%) | 0.005 | 55 (23.5%) |
| Produce an antibiogram | 50 (51.5%) | 61 (44.5%) | 0.354 | 63 (74.1%) | 29 (30.5%) | 19 (35.2%) | < 0.001 | 111 (47.4%) |
| Monitor antibiotic use (consumption) |
| Antibiotic(s) administered to patients per day | 53 (54.6%) | 76 (55.5%) | 1.000 | 54 (63.5%) | 48 (50.5%) | 27 (50.0%) | 0.149 | 129 (55.1%) |
| Number of grams of antibiotics used | 46 (47.4%) | 65 (47.4%) | 1.000 | 45 (52.9%) | 45 (47.4%) | 21 (38.9%) | 0.270 | 111 (47.4%) |
| Direct expenditure for antibiotics | 63 (64.9%) | 71 (51.8%) | 0.062 | 46 (54.1%) | 60 (63.2%) | 28 (51.9%) | 0.311 | 134 (57.3%) |
| REPORTING INFORMATION TO STAFF ON IMPROVING ANTIBIOTIC USE AND RESISTANCE |
| Share facility-specific reports | 67 (69.1%) | 74 (54.0%) | 0.029 | 57 (67.1%) | 57 (60.0%) | 27 (50.0%) | 0.134 | 141 (60.3%) |
| Has a current antibiogram | 60 (61.9%) | 63 (46.0%) | 0.024 | 60 (70.6%) | 40 (42.1%) | 23 (42.6%) | < 0.001 | 123 (52.6%) |
| Prescribers receive direct, personalized communication | 64 (66.0%) | 77 (56.2%) | 0.171 | 62 (72.9%) | 53 (55.8%) | 26 (48.1%) | 0.007 | 141 (60.3%) |
| EDUCATION |
| Provide education | 72 (74.2%) | 87 (63.5%) | 0.112 | 64 (75.3%) | 63 (66.3%) | 32 (59.3%) | 0.129 | 159 (67.9%) |