4. Unit ? *This question is required.

• NICU/SCN
• NBN

6. Do you have set criteria for determining at-risk sepsis in infants? *This question is required.

• Yes
• No

7. Do you use the Kaiser Early Onset Sepsis Calculator on infants greater than 34 weeks? *This question is required.

• Yes
• No

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.

• Yes
• No

9. Do you engage families to provide education on the necessity and appropriate use of antibiotics?  *This question is required.

• Yes
• No

10. Does your unit use electronic systems to prescribe, dispense, or administer medications?  *This question is required.

• Computerized physician order entry or an order management system (CPOE or CPROM)
• Electronic medication administration record (eMAR)
• Bar coded medication administration (BCMA )

Which EMR do you use? *This question is required.

• Epic
• Cerner
• McKesson
• Allscripts
• Siemens
• Other

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.

• Yes
• No

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.

• Yes
• No

13. Do prescribers in your unit receive direct personalized communication about how they can improve their antibiotic prescribing?  *This question is required.

• Yes
• No

14. Do nurses in your unit have a formal handoff process that includes review of antibiotic dose, duration and indication?  *This question is required.

• Yes
• No

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.

• Yes
• No

16. Does your unit monitor and report antibiotic use for > 48 hours in infants with negative blood, cerebral spinal fluid, or urine cultures?

• Yes
• No

17. Who at your organization reviews blood culture results and adjusts type of antibiotic used based on organism identification? *This question is required.

• Pharmacist
• Physician
• Nurse Practioner / Mid-level Provider
• Other

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.

• Neonatologist
• Pharmacist
• Infection Prevention and Health Care Epidemiologist(s)
• Infectious Disease Specialist(s)
• Quality Improvement Specialist(s)
• Microbiology Laboratory Technician(s)
• Information Technologist(s) (IT)
• Nurse(s)
• Nurse Practitioner(s) / Physician Assistant(s)
• Parent(s) / Consumer Advisor(s) withdrawal?
• No team

19. Does your hospital report antibiogram data to your unit for review?  *This question is required.

• Yes
• No

20. Are you able to chart “teach back” education with your families in your EMR? *This question is required.

• Yes
• No