Tools and Templates for Acute Care
Resources developed by Nebraska ASAP are intended for non-commercial educational and quality improvement purposes. Please acknowledge Nebraska ASAP when they are used.
Below is a collection of tools and templates developed for acute care facilities. These documents can be adopted to the needs of individual facility for improvement in antibiotic prescribing practices.
Adverse Drug Reaction Worksheet (PDF format) (Word format)
Antibiogram Templates for Frequently Isolated Pathogens, with Summary Comments
Antibiotic Use Tracking Template
Antimicrobial Stewardship Intervention Database Template
Antimicrobial Stewardship Recommendation Form Template
Antimicrobial Stewardship Self-Assessment Instrument for Acute Care Hospitals
Automatic IV to PO Antibiotic Conversion Policy Template
Daily Antibiotic Therapy Checklist Template
Institutional Policy Template for Hospital ASP
Leadership Support Statement Template for Hospital ASP
MRSA Nasal Screening Protocol for Antimicrobial Stewardship
Piperacillin-tazobactam Therapy Checklist Template
