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Perinatal Quality Collaborative of North Carolina

Page One


This question requires a valid date format of MM/DD/YYYY.
4. Unit ? *This question is required.
This question requires a valid number format.
6. Do you have set criteria for determining at-risk sepsis in infants? *This question is required.
7. Do you use the Kaiser Early Onset Sepsis Calculator on infants greater than 34 weeks? *This question is required.
8. Do you have protocols or standing orders established to determine when to start and stop antibiotics on infants at risk for early onset sepsis? *This question is required.
9. Do you engage families to provide education on the necessity and appropriate use of antibiotics?  *This question is required.
10. Does your unit use electronic systems to prescribe, dispense, or administer medications?  *This question is required.
Which EMR do you use? *This question is required.
11. Does your unit have a policy that requires prescribers to document in the medical record or during order entry the dose, duration, and indication for all antibiotic prescriptions?  *This question is required.
12. Do antibiotics prescribed need to be approved by a physician (such as an infectious disease specialist) or a pharmacist prior to dispensing (i.e. pre- authorization)? *This question is required.
13. Do prescribers in your unit receive direct personalized communication about how they can improve their antibiotic prescribing?  *This question is required.
14. Do nurses in your unit have a formal handoff process that includes review of antibiotic dose, duration and indication?  *This question is required.
15. Is there a formal process prompting your medical care team to review the appropriateness of all antibiotics prescribed for infants 48 hours after the initial order (e.g. "antibiotic time out") *This question is required.
16. Does your unit monitor and report antibiotic use for > 48 hours in infants with negative blood, cerebral spinal fluid, or urine cultures?
17. Who at your organization reviews blood culture results and adjusts type of antibiotic used based on organism identification? *This question is required.
18. Does your unit have a multidisciplinary team responsible for antibiotic stewardship?   If yes, which of the following are members of the multidisciplinary team?  *This question is required.
19. Does your hospital report antibiogram data to your unit for review?  *This question is required.
20. Are you able to chart “teach back” education with your families in your EMR? *This question is required.