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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

 

Piperacillin-tazobactam Therapy Checklist Template

 

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