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Table 1 Overview of literature scan and extracted implementation topics

From: Evaluation of early implementations of antibiotic stewardship program initiatives in nine Dutch hospitals

# Author (s) Year Title Study description Extracted implementation topics
1 Bannan, Buono, McLaws, Gottlieb 2009 Survey of medical staff attitudes to an antibiotic approval and stewardship program Design: - restriction as intervention
Questionnaire with 40 questions focused on restriction and approval - authorization as intervention
Interest: - advice as communication
- education as intervention
Attitude - stop-order (withholding pharmacy) as intervention
- costs, appropriate use, resistance, time as outcomes
- pager as communication
- possible stakeholders in team
2 Barlam, DiVall 2006 Antibiotic-stewardship practices at top academic centers throughout the united states and at hospitals throughout Massachusetts Design: - multifaceted programs
Two surveys - time of start with ASP
Interest: - funding/financial support
ASP components - (formulary) restriction as intervention
- solicited input from ID as communication
- costs, improved use, adverse effects, resistance, compliance, DDDs, clinical outcomes as outcomes
- aiming prophylaxis
- aiming only targeted antibiotics
- aiming antibiotic therapy at order
- aiming initial therapy
- recommendations as intervention (day 3 bundle)
- culture data as communication
- possible stakeholders in team
- approval as intervention
- review as communication
- consult as communication
- computerized order entry as communication
- stop-order as intervention
- IV-PO switch as intervention
- clinical practical guidelines as intervention
- evaluation as intervention (benchmarking)
- support and time needed from physicians
- rounds, didactics, program, consults/feedback as education
3* Burgmann, Janata, Allerberger, Frank 2008 Hospital antibiotic management in Austria – results of the ABS maturity survey of the ABS International group Design: - data evaluation as intervention (benchmarking)
Survey - AB consumption data as outcomes
Interest: - hospital/department/ward levels of benchmarking
5 categories of maturity - feedback of benchmarking as communication
- possible stakeholders in team
- guidelines for dosage, drug costs, IV-PO switch
- guidelines for antibiotic treatment
- guidelines for prophylaxis
- education as intervention (seminars, literature)
- financial resources
- cooperation with other hospitals
4 Buyle, Metz-Gercek, Mechtler, Kern, Robays, Vogelaers, Struelens 2013 Development and validation of potential structure indicators for evaluating antimicrobial stewardship programmes in European hospitals Design: - bedside advice as communication
Expert panel + validation survey - rounds as intervention
- frequency of team meetings
Interest: - audit as intervention
Potential structure indicators for ASP - possible stakeholders in team
- formulary as intervention
- updating formulary
- stop order as intervention
- guidelines for microbiological documented therapy, empirical therapy, prophylaxis, iv-po switches
- updating guidelines
- clinical decision aid as IT
- mandate from management
- FTEs
- Education as interventions
- passive methods, interactive methods as education
- evaluation as intervention
- resistance data, consumption data,
- hospital/department/ward levels of benchmarking
- total DDDs, # of infections as outcomes
5 Cooke, Alexander, Charani, Hand, Hills, Howard, Jamieson, Lawson, Richardson, Wade 2010 Antimicrobial stewardship: an evidence-based, antimicrobial self-assessment toolkit (ASAT) for acute hospitals Design: - guidelines as intervention
ASAT toolkit (checklist) - formulary as intervention
Interest: - restriction as intervention
Levels of antimicrobial stewardship - IV-PO switches as intervention
- guidelines for prophylaxis as intervention
- adherence as outcome
- education as intervention
- training as education
- information systems as IT
- digital prescribing as IT
- possible stakeholders in team
6 Dumartin, Rogues, Amadeo, Pefau, Venier, Parneix, Maurain 2011 Antibiotic stewardship programmes: legal framework and structure and process indicator in Southwestern French hospitals, 2005–2008 Design: - frequency in meetings
Survey - available human resources
Interest: - digital prescription, pharmaceutical analysis, dispensation, digital link between lab, pharm, wards as IT
Checking whether legal framework is present - restriction as intervention
- stop order as intervention
- first-line, prophylaxis as guidelines
- audits as intervention/communication
- evaluation feedback as communication
- education as intervention
- Formulary as intervention
- ab consumption as benchmarking
- DDDs, resistance as outcomes (and communication)
- possible stakeholders in team
7 van Gastel, Costers, Peetermans, Struelens 2010 Nationwide implementation of antibiotic management teams in Belgian hospitals: a self-reporting survey Design: - Possible stakeholders in team
Questionnaire - consultation per phone, email, intranet, face-to-face, staff meetings as communication
Interest: - formulary as intervention
Level of AMT activities - guidelines for empirical and prophylaxis
- updates of formulary and guidelines
- restriction as intervention
- approval/review as intervention
- concurrent review/audit as intervention
- de-escalation as intervention
- stop order as intervention
- order forms as intervention
- IV-PO switch as intervention
- consumption and resistance as outcomes
- by hospital/unit or by antibiotic type
- feedback of outcomes
8 Greater New York Hospital Association 2011 Antimicrobial stewardship toolkit Design: - benchmark and review antibiotic use (patterns)
Best practice - review resistance
Interest: - IT infrastructure
Implementation toolkit - possible stakeholders in team
- aim for common infections, pathogens, agents
- rollout: hospital vs. ward
- available resources
- strategy:
- guidelines for diagnosis, treatment, duration, dose optimization, IV-PO, streamlining/de-escalation
- formulary as intervention
- restriction as intervention
- education as intervention
- prospective review as intervention
- stickers, notes, face-to-face as communication
- data collection (benchmarking)
- usage, clinical, microbiologic, costs as data
9 Hulscher, Grol, van der Meer 2010 Antibiotic prescribing in hospitals: a social and behavioral scientific approach Design: - formulary as intervention
Review - order form as intervention
Interest: - restriction as intervention
socio-cultural factors of ASP - stop orders as intervention
- infection control committee
- guidelines as intervention
- review as intervention
- rounds as intervention
- telephone advice as intervention
- improve infrastructure
- education as intervention
- conferences, seminars, skill training programs as education
- individual instructions (outreach, academic detailing)
- feedback of outcomes
- decision support via IT
10 Nault, Beaudoin, Thirion, Gosselin, Cossette, Valiquette 2008 Antimicrobial stewardship in acute care centres: survey of 68 hospitals in Quebec Design: - Duration of ASP or busy setting up
Questionnaire - distributed units, DDDs, acquisition costs as benchmarking data
Interest: - direct interaction as intervention (written or phone)
Proportion and nature of programs - education as intervention
- stop orders as intervention
- auto substitution
- formulary restriction as interventions
- local guidelines as intervention
- preauthorization as intervention
- antibiotic cycling as intervention
- decision support systems as intervention
- possible stakeholders in team
11 Pulcini, Williams, Molinari, Davey, Nathwani 2011 Junior doctors’ knowledge and perceptions of antibiotic resistance and prescribing: a survey in France and Scotland Design: - local guidelines as intervention
Survey - presence of team-
Interest: - approval as intervention
Perception and prescribing practice - IV-PO switch protocol
- advice from ID physician, senior, microbiologist, pharmacist or team as intervention
- face-to-face, phone, consult upon request as communication
- lectures, workshops, informal education, web-based learning, self-directed learning as education
- possible stakeholders in team
- computer aided prescribing as IT
- resistance data availability
12 Thern 2013 Selection of hospital antimicrobial prescribing quality indicators: Design: - possible stakeholders in team
a consensus among German antibiotic stewardship (ABS) networkers Review+ - frequency of meetings
questionnaire - mandate
Interest: - drug use, resistance rates as data
Indicators for quality of AB prescribing - formulary as intervention
- updating formulary
- restriction/approval as intervention
- guidelines for empiric therapy, IV-PO, dosing, prophylaxis,
- rounds as intervention
- education as intervention
- guidance or assisted decision analysis via IT
13 Trivedi, Rosenberg 2013 The state of antimicrobial stewardship programs in California Design: - implemented or planned ASP
Survey - time of start with ASP
Interest: - possible stakeholders in team
State of ASP - FTE availability
- - funding
- benchmarking as intervention
- DDDs, DOTs, costs, acceptance of recommendations, improved susceptibility patterns as data
- use of IT in ASP
- electronic health record, digital prescription, electronic medication administration records as IT
- formulary restriction as intervention
- ID physician consult as intervention
- audit as intervention
- prior approval as intervention
- auto stop orders as intervention
- verbal approval as intervention
- pre-authorization as intervention
- education as intervention
- guidelines as intervention
- IV-PO switch as intervention
- streamlining/de-escalation as intervention
      - order forms as intervention
  1. *) DDDs: daily defined doses; DOT: days of therapy; FTE: full-time equivalent; ID: infectious diseases; IV-PO: intravenous-per os; IT: information technology.