Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY

JAN 17 21119

ADMINISTRATIVEORDER
Now-1879' 20194002

SUBJECT: Implementing Guidelines on the Philippine Antimicrobial

Stewardship (AMS) Program for Hospitals

I. BACKGROUND

Antimicrobial resistance (AMR) is a significant public health threat that

causes major health and economic consequences both in human and veterinary health.
It claims lives, prolongs illnesses, increases healthcare costs and financial burden,
adversely affects trade, as well as threatens national and global security. In the
Philippines, the Antimicrobial Resistance Surveillance Program (ARSP) found very
alarming resistance rates among various pathogens.

In 2009, the Health Facilities Development Bureau (HFDB) formerly National

Center for Health Facilities Development (NCHFD) of the Department of Health
(DOH) published the National Standards in Infection Control for Healthcare Facilities
to strengthen infection prevention and control (IPC) programs nationwide and prevent
the occurrence of healthcare-associated infections (HAI) among patients. It also
provided guidelines for the hospital management, service providers and support staff
on the provision of quality services at various aspects of work and service delivery
points in the hospital.

The Office of the President issued in 2014 the Administrative Order (AO) No.
42 entitled “Creating an Inter-Agency Committee for the Formulation and
Implementation of a National Plan to Combat Antimicrobial Resistance in the
Philippines” to bring together all key partners across many sectors towards
identifying and implementing concrete efforts and plans to mitigate and control AMR.
The Department of Health (DOH) led the finalization of “The Philippine Action Plan
to Combat Antimicrobial Resistance: One Health Approach” through the Inter-
Agency Committee on AMR (ICAMR) which was launched during the 15’t Philippine
AMR Summit in 2015. Stipulated in the action plan are the country strategies that
focus on the following core areas: leadership and governance; surveillance and
laboratory capacity; access to essential medicines of assured quality; awareness and
promotion; infection prevention and control; rational antimicrobial use among
humans and animals; and research and development.

In response to the prevailing epidemiologic trends of infectious diseases, AO

No. 2016-0002 entitled “National Policy on Infection Prevention and Control in
Healthcare Facilities” was issued by HFDB to further provide guidance and
strengthen the implementation of IPC programs across hospitals. The A0 No. 2016-
0002 outlines 14 priority areas of IPC programs to be established in
healthcare?
Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila 0 Trunk Line 651-7800 Local 1113, 1108, 1 135
Direct Line: 711—9502; 711-9503 Fax: 743-1829 0 URL: http://www.doh.gov.ph' e-mail: ftduqueféidohiiovph /
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 facilities. Included in the list is the institutionalization of an Antimicrobial
Stewardship (AMS) Program that aims to strengthen the knowledge, attitude and
practices of involved stakeholders on rational prescribing, dispensing and use of
antimicrobials; and, to improve patient outcomes by decreasing infections caused by
resistant organisms.

The World Health Organization (WHO) defined AMS as a multidisciplinary,

multi-intervention, coordinated approach to improve the appropriate use of
antimicrobials by promoting the selection of the optimal antimicrobial drug regimen
to ensure that the right choice of antibiotic, right route of administration, right dose,
right time, and right duration of treatment are strictly observed to minimize harm to
the patients. To set the standards on the implementation of the AMS program in
hospitals, the DOH hereby issues this Order.

II. OBJECTIVES

General Objective:

This Order aims to define the overall framework and strategic directions to
implement the Philippine Antimicrobial Stewardship (AMS) Program in all hospitals
nationwide towards improving the use of antimicrobials, mitigating, and preventing
the emergence of antimicrobial resistance (AMR) in the Philippines.

Specific Objectives:

The implementation of the Philippine AMS Program aims to:

1. Promote rational and optimal antimicrobial therapy;

2. Effect positive behaviour and institutional changes towards ensuring the optimal
use antimicrobials by the prescribers, dispensers, other healthcare professionals,
and patients in the hospitals;

3. Establish multidisciplinary leadership and commitment, clinical governance and

accountability in antimicrobial management and control ensuring that
interventions are sustainable and well-supported with necessary technical and
financial resources;

4. Create an environment where healthcare professionals are supported with tools

and systems to implement antimicrobial management;

III. SCOPE AND COVERAGE

This Order shall be applicable to all Level 1, 2, and 3 hospitals in the

Philippines, both in the public and private sector.
IV. DEFINITION OF TERMS

1. Antimicrobial Resistance (AMR) — is the defense mechanism developed by a

microorganism (including bacteria, viruses and some parasites) to an antimicrobial
drug to which it was previously sensitive. AMR, which is a consequence of the
use or misuse of an antimicrobial agent, ensues when a microorganism mutates or
acquires a resistant gene. Resistant organisms withstand attack by antimicrobial or
antiparasitic agents so that standard treatments become ineffective, allowing
infections to persist and spread.

AMR Surveillance — is the tracking of changes in microbial populations which

permits the early detection of resistant strains of public health performance
resulting in the prompt notification and investigation of outbreaks.

Antibiogram — is an overall profile of antimicrobial susceptibility testing results

of a specific microorganism to a battery of antimicrobial drugs.
Antimicrobial Resistance Surveillance Program (ARSP) — is a laboratory-
based surveillance system in selected hospital sentinel sites that determines the
current status and developing trends of resistance of selected bacteria to specific
antimicrobials, with the Research Institute for Tropical Medicine (RITM) as the
DOH national reference laboratory.

Antimicrobial Stewardship (AMS) — refers to a multidisciplinary, multi-

intervention, coordinated approach to improve the appropriate use of
antimicrobials by promoting the selection of the optimal antimicrobial drug
regimen to ensure the right choice of antibiotic, right route of administration, right
dose, right time, and right duration to minimize harm to the patient and future
patients.

Antimicrobial Use (AMU) Surveillance — is the act of tracing how and why

antimicrobials are being used and misused by patients and healthcare providers.

Automatic Stop-order — refers to the method of appropriately limiting the

duration of antimicrobial usage which can be employed for the use of empiric or
therapeutic antimicrobials.

De-escalation Therapy — refers to the method of narrowing the spectrum of an

empiric antimicrobial regimen which includes adjusting an empiric antibiotic
regimen on the basis of culture results and other data; and, discontinuing empiric
therapy if testing subsequently fails to demonstrate evidence of an infectious
process.

Dose Optimization — refers to the method of ensuring that specific characteristics

of the drug (e. g., concentration or time-dependent killing, toxicities), the
infectious agent (e.g., minimum inhibitory concentration), the patient (e.g.,
weight, renal function), and the site of infection are all taken into account in the
treatment.

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_
10. Emerging Infectious Diseases (EIDs) — are newly identified, previously
unknown, or drug-resistant infections whose incidence in human has increased
within the past two decades or whose incidence threatens to increase in the near
future.

11 Infection Control Committee (ICC) — refers to a body that provides a forum for
multidisciplinary input cooperation and information sharing tasked to ensure
overall implementation of infection control strategies by formulating and updating
infection control policies, guidelines and procedures. Representation includes
management, physicians, and other healthcare workers from clinical
microbiology, pharmacy, sterilizing service, housekeeping and training services.

12. Infection Prevention and Control (IPC) — refers to the discipline which
comprises measures, practices, protocols and procedures all aimed at preventing
and controlling the development of new infections acquired in healthcare settings.

13. Intravenous to Oral Antimicrobial Therapy Switch — refers to the method of

changing from intravenously administered antimicrobials to orally administered
antimicrobials used for antimicrobial agents with which similar concentrations are
achieved whether administered intravenously or orally.

14. National Antibiotic Guidelines Committee (NAGCom) — is a technical

committee at the DOH composed of specialists on infectious diseases created to
develop antibiotic guidelines for health facilities aiming to provide information on
the treatment of choice/ recommendations for selected pathogen-specific
conditions based on recent evidences of clinical effectiveness, adverse effects,
cost and patterns of resistance, and, necessary dosing and monitoring guidelines
for specific antimicrobials.

15. National External Quality Assessment Scheme (NEQAS) — refers to the

external evaluation of a laboratory’s performance using proficiency panels which
aims to evaluate the effectiveness of the quality assurance program.

16. Philippine National Formulary (PNF) — refers to the list of medicines prepared
and periodically updated by the DOH that satisfy the priority health care needs of
the population and which are selected based on evidence of their efficacy, safety
and comparative cost-effectiveness. This serves as the national reference for
quality and rational selection of the medicines which are vital in achieving the
best health outcomes.

17. Pharmacy and Therapeutics Committee (PTC) — is the primary multi-

disciplinary body of the hospital or government health unit that governs issues
related to medicines such as evaluation, selection, rational use and other related
matters.

18. Point-of-care (POC) Interventions — are interventions that occur at the ward
level with the treating medical team, often soon after empirical therapy has been
initiated. These provide direct feedback to the prescriber at the time of
prescription or laboratory diagnosis, and provide an opportunity to educate
clinical staff on appropriate prescribing.

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 GENERAL GUIDELINES

1. The national AMS program for hospitals shall be created as part of the overall
comprehensive National Action Plan to Combat AMR, pursuant to A0 42 series
of 2014. The program shall be headed by the Pharmaceutical Division (PD) of the
DOH Central Office in partnership with the Health Facilities and Services
Regulatory Bureau (HFSRB) and the Health Facility Development Bureau
(HFDB).

The AMS program shall be based on six core elements stated in the implementing
guidelines, namely: (1) leadership; (2) policies, guidelines, and pathways; (3)
AMR and antimicrobial use (AMU) surveillance; (4) action; (5) education; and (6)
performance evaluation. These shall provide a systematic approach to optimize
the use of antimicrobials within the facility reducing adverse consequences of
antimicrobial use which include AMR, toxicity and unnecessary healthcare costs.

The AMS Program shall be part of the overall initiatives in improving patient
safety; quality of care; national policy for infection prevention and control;
management of emerging infectious diseases; and the current hospital licensing
standards of the DOH.

All hospitals shall establish an effective and efficient AMS program that involves
a multidisciplinary, multi-intervention and coordinated strategy to optimize the
use of antimicrobials. This shall be led by an AMS Committee in partnership with
the Pharmacy and Therapeutics Committee (PTC), the Infection Control
Committee (ICC) and the Patient Safety Committee to enable a holistic and
coordinated approach in implementing AMS strategies. In cases where it cannot
be instituted due to variations across the health facilities depending on available
resources and expertise, hospitals are granted with flexibility where to place the
AMS program considering existing hospital management structure, as long as
accountabilities are clear and outputs are delivered.

. An AMS Steering Committee composed of experts from key professional

societies and representatives from relevant DOH units shall be created to develop
the AMS Manual of Procedures (MOPS) and oversee the conduct of monitoring
and evaluation of the AMS program implementation in all hospitals.

The DOH shall identify hospitals which shall serve as training hubs that shall
provide infrastructure for multi-professional skills training and education on AMS
programs in hospitals.

VI. IMPLEMENTING GUIDELINES

The hospitals shall be governed by the six (6) AMS core pillars:

A. Leadership

1. The Chief of Hospital and designated members of the hospital administration

shall be responsible and accountable in implementing AMS in their facility
 and shall ensure leadership and management support through but not limited
to the following:

a. Dedicating sufficient funding and resources for AMS-related activities;

b. Allowing the staff to contribute to the AMS goals of the hospital through
participation in the hospital stewardship program;
0. Supporting training and continuous education;
(1. Ensuring accountability from all levels and across relevant clinical
departments through continuous monitoring of performance; and,
e. Building an enabling environment to support AMS-related activities such
as setting up an information technology (IT) system to monitor antibiotic
use or antibiotic alert systems

2. The Chief of Hospital shall create a governance structure through an issuance

that shall define the different roles and responsibilities, and job descriptions of
all hospital staff in stewardship-related activities and other relevant initiatives
on infection prevention and control.

3. The AMS Committee shall be composed of an infectious disease specialist

(IDS), medical microbiologist, AMS clinical pharmacist, representatives from
the AMS Team, clinicians fiom key medical and surgical departments, and
members of the hospital management, to include members of other related
groups such as the PTC and ICC.

4. The AMS Team shall be composed of an Infectious Disease Specialists (IDS)

(Levels 2 and 3 hospitals), AMS-trained physician (Level 1 hospitals), AMS
Clinical Pharmacist, and an Administrative Staff.

B. Policies, Guidelines, and Clinical Pathways

1. All hospitals shall have an antibiotic policy to promote rational prescribing

and dispensing practices.

2. All hospitals shall adopt or adapt to their local context the National Antibiotic
Guidelines to guide the clinicians in the management of infectious diseases.

3. The AMS Committee, together with the PTC and ICC, shall be responsible for
the development, implementation and revisions of the hospital antimicrobial
policy, standard guidelines and pathways, with the support and commitment
from the hospitals administration.

4. The policy, guidelines, and pathways shall be reviewed regularly and updated
as needed to determine if these are still effective based on the hospital’s AMR
rates and antimicrobial use data.

C. Surveillance of AMU and AMR

1. The AMS Committee shall ensure the regular Antimicrobial Use (AMU)
monitoring which shall be reported to DOH-PD annually and to relevant
hospital departments as well.

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 All hospitals shall conduct AMR surveillance and develop annual institutional
antibiogram (through the AMS Committee and the microbiology laboratory)
for reportable pathogens which shall be identified in the AMS MOPs defined
by the Antimicrobial Resistance Surveillance Program (ARSP) at least once a
year, which shall be submitted annually to the Research Institute for Tropical
Medicine (RITM). For hospitals without an on-site microbiology laboratory,
microbiological culture and sensitivity results shall be obtained from external
laboratories for their own set of patients so they can develop their own
antibiogram.

The microbiology laboratory of the hospital shall participate and pass both the
National External Quality Assessment Scheme (NEQAS) for microbiology
and the Antimicrobial Resistance Surveillance Program Bacteriology
Laboratory Accreditation for PhilHealth reimbursement of select
antimicrobials in the Philippine National Formulary (PNF).

The hospital management shall strengthen the capacity for laboratory

surveillance that shall allow monitoring of antimicrobial susceptibility patterns
and detection of resistant pathogens.

D. Action

1. The hospital shall employ a comprehensive combination of persuasive and

restrictive interventional strategies which shall be listed in the AMS MOPs to
safeguard and ensure the optimal use of all antimicrobials used within the
facility. These may include antimicrobial restriction and pre-authorization,
seventh day automatic stop order, audit and feedback, and point-of-care (POC)
interventions such as dose optimization, streamlining or de-escalation of
antimicrobial therapy and intravenous to oral antimicrobial therapy switch.

All antimicrobials prescribed and used for admitted patients within the
hospital shall be subjected to the interventions of the AMS program.

E. Education

1. The PD shall disseminate the AMS MOPS to all levels of hospital care.

2. All hospitals shall aim to provide training and continuous education to

healthcare staff, who are in contact with patients on antibiotics. These include
not only the prescribers (i.e. attending physicians), nurses, clinical
pharmacists, microbiologists, and midwives, but also medical students and
paramedical staff under training to ensure that the transfer of basic and
advanced scientific knowledge and skills on the proper use of antibiotics
occurs at an early stage.

The AMS Committee shall ensure that the above-mentioned hospital

personnel attend the standard Training Course on AMS through an education
program certified or recognized by the DOH.

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 4. Hospitals, especially the teaching and training institutions, shall also develop
training modules with clear learning outcomes and competencies on AMS
covering microbiology, prevention and control of infectious diseases, clinical
pharmacology, hospital pharmacy and patient communication skills and the
prudent use of antibiotics.

5. AMS Practitioners shall continually update themselves on the newest

developments in the area of microbiology, infectious disease management and
prevention, pharmacotherapy, and AMS practice.

6. All hospitals shall ensure that systems are in place for patient education and
counselling on how to take their prescribed antimicrobials correctly and use
antimicrobials responsibly.

7. The DOH shall identify public and private hospitals which shall serve as the
AMS training hubs and forge a partnership based on the existing rules and
regulations. These institutions shall:

a. Facilitate and organize the conduct of the AMS training

b. Manage the administrative matters related to the conduct of the activity

including the management and disbursement of funds, and
coordination with the participants

c. Perform secretariat functions which are, but not limited to:

i. Preparation and organization of programme (based on the DOH
prescribed content)
ii. Selection and invitation of resource persons
iii. Provision of logistical support
iv. Documentation of issues raised during the training program
v. Coordination with the DOH AMR secretariat for the pre- and
post-training activities (including the preparation of necessary
reports)

d. Submit sub-allotment utilization/liquidation report to the DOH-PD (for

public training hubs only)

F. Performance Evaluation

1. An AMS Steering Committee (ASC) shall be created to oversee the conduct of

monitoring and evaluation of the AMS program and provide relevant
evidence-based recommendations to the DOH.

2. The AMS Committee of all hospitals shall submit to the DOH PD an annual
AMS program monitoring report based on the tool developed (Annex A) for
tracking of progress of the AMS Program.

f 8

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VII. ROLES AND RESPONSIBILITIES

A. Department of Health Central Office

1. Pharmaceutical Division (PD)

a. Facilitate the development of the AMS MOPS which shall stipulate the
details of the AMS implementation in the hospitals.

b. Lead the overall monitoring of the implementation of the AMS program in

hospitals in partnership with the HFDB and HFSRB.

c. Provide technical assistance on the implementation of the program through

the dissemination of the AMS MOPS and participation in the training r011-
outs.

d. Convene and provide technical and administrative support to the

NAGCom in the updating of the national antibiotic guidelines and ASC in
formulating their AMS program recommendations.

e. Provide technical assistance on AMU surveillance and interpret

antimicrobial consumption data submitted by the hospitals and publish
annual report.

f. Collect and analyze monitoring and evaluation reports from hospitals.

2. Disease Prevention and Control Bureau (DPCB)

a. Identify DOH-accepted Clinical Practice Guidelines of infectious diseases

that are of public health importance for adoption of the hospitals.

b. Inform the relevant agencies on the updated treatment guidelines of the

respective public health programs.

c. Develop standards and protocols on managing emerging infectious

diseases (EIDs) in partnership with EB, HFDB and RITM.

3. Epidemiology Bureau (EB)

a. Provide technical assistance on epidemiology and surveillance for

hospital-acquired infections (HA1), and AMR.

b. Serve as the national collaborating center for the reported AMR cases in
hospitals which include diseases of public health importance and these
pathogens being monitored through the ARSP.

4. Field Implementation and Coordination Team (FICT)

a. Ensure adherence of all hospitals to the guidelines of the AMS

implementation.

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. Health Facility Development Bureau (HFDB)

a. Participate in the monitoring of AMS implementation in hospitals in

partnership with the PD and HFSRB.

b. Ensure that AMS program is aligned to the National Infection Prevention

and Control Policy and, the overall quality of care and patient safety.

. Health Facilities and Services Regulatory Bureau (HFSRB)

a. Ensure that the institutionalization and effective implementation the AMS

program, and integration of the AMS program and reporting of AMR
surveillance data are part of the licensing and re-licensing requirements of
hospitals.

b. Ensure that ICC and PTC in hospitals are functional as part of the
minimum licensing requirements and compliant with the DOH program
policies on antimicrobial resistance.

0. Perform corresponding regulatory actions for hospitals that will deviate

from the timeline (Annex B) of AMS institutionalization in their facilities.

. Food and Drug Administration (FDA)

a. Ensure the safety, efficacy, and quality of antimicrobials available in the

market.

b. Advocate the standards on the good storage and distribution practices of

antimicrobials within the hospital to ensure that their quality and integrity
are maintained.

c. Evaluate the reports received from the hospitals on antimicrobials that

resulted in failure of therapy.

. Philhealth

a. Ensure reimbursement of antimicrobials listed in the PNF.

. Research Institute for Tropical Medicine (RITM)

a. Oversee the implementation of ARSP in hospitals.

b. Monitor generation of data on AMR patterns in the hospitals.

0. Provide technical assistance in maintaining AMR surveillance.

(1. Generate and disseminates countrywide ARSP data.

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B. DOI-I Regional Offices

1. Ensure that all antimicrobials are rationally prescribed, dispensed and used by
all healthcare professional and patients by practicing AMS at all levels of
healthcare towards successfully combatting AMR in the region.

2. Provide technical support on the AMS implementation to the hospitals in their

respective regions.

3. Furnish the DOH PD feedback report on the status of hospitals implementing

the AMS program.

C. Hospitals

1. Chief of Hospital or Medical Director together with the members of the

hospital administration shall:

a. Ensure that a local framework for AMS program is in place.

b. Dedicate sufficient funding and resources for AMS-related activities for

the operations of the AMS Team.

c. Establish an enabling environment to support AMS-related activities.

(1. Allow staff to contribute to the AMS goals of the hospital through
participation in the hospital AMS program.

e. Support AMS-related training and continuous education.

f. Ensure accountability from all levels and across relevant clinical

departments through continuous monitoring of performance.

2. AMS Committee

a. Develop and maintain antimicrobial policies, forrnulary, and clinical

practice guidelines for antimicrobial treatment and prophylaxis.

b. Supervise the overall implementation, monitoring of the effectiveness and

championing the efforts to improve the hospital’s AMS program and
initiatives with direct accountability to the PD.

0. Ensure the availability of resources for the sustainability of the AMS

program.
(1. Collaborate with the Pharmacy and Therapeutics Committee (PTC) and
Infection Control Committee (ICC) in promoting rational use of
medicines.

W11
 e. Provide feedback to prescribers and conduct educational activities for
medical, nursing and pharmacy staff on antimicrobial prescribing and
AMS principles.

f. Monitor antimicrobial usage and resistance.

3. AMS Team

a. Implement the AMS strategies and perform AMS interventions as needed.

b. Develop and review standard treatment guidelines and prescribing

policies.

0. Regularly collect, analyze and report the progress of the AMS program to
the hospital AMS Committee, administrators, and DOH.

d. Educate healthcare staff on appropriate antimicrobial prescribing and

resistance.

e. Identify and design systems/processes to facilitate appropriate

antimicrobial use.

f. Provide expert advice on the development of policies related to appropriate

use of antimicrobials and control of AMR in the hospital.

4. ICC and PTC

Maintain the antimicrobial policies and formulary, and ensure that they
remain current and adhered to.

Develop, maintain and disseminate the hospital program.

Lead in the creation of evidence-based treatment and surgical prophylaxis

guidelines that are incorporated into the antimicrobial policy.

d. Monitor the process and outcome measures of antimicrobial policies.

5. Microbiology Laboratory Department

a. Ensure the timely identification of pathogens and the quality performance

of routine antimicrobial susceptibility testing.
Provide microbiological expertise in the development and review of
standard treatment guidelines and forrnulary restrictions.

Participate in the evaluation of AMU and AMR surveillance.

Assist in infection prevention and control efforts.

AX;
VIII. MONITORING AND EVALUATION

A. The DOH PD through the ASC shall be responsible for the implementation and
monitoring of the AMS program in hospitals.

B. The HF DB and HFSRB shall ensure that the health facilities are compliant with
the prescribed standards necessary for the fulfilment of licensing and re-licensing
requirements of hospitals.

C. The monitoring and evaluation of the AMS program in hospitals shall be

documented which shall always be available for public health purposes.

IX. FUNDING SOURCE

The budget for the national implementation of the AMS program shall be derived
from the funds of the DOH PD and the resources provided by development partner
organizations. The hospitals shall incorporate in their annual budget plan line items
related to the AMS implementation and ensure the sustainability of the program.

REPEALING CLAUSE

All previous Orders inconsistent in part or in whole to this Administrative Order

are hereby rescinded or amended accordingly.

XI. EFFECTIVITY

This Order shall take effect immediately.

FRANC CO . DUQUE III, MD, MSc

Se etary of Health

13

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 ANNEXA
V

Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY

ANTIMICROBIALSTEWARDSHIP (AMS) MONITORINGTOOL

FOR HOSPITALS

Name of Hospital: Region/Province:

Address: Date of Visit:
Time started:

A. Leadership
1. Is there an existing hospital policy for the implementation of the Antimicrobial Stewardship (AMS) program?
_
Yes
No
_ /
If yes, when was the AMS hospital policy signed? (dd mm/yyyy):
If no, when does the hospital aim to issue a policy?
2. Which of the following handles the AMS program in your hospital?

_
Antimicrobial Stewardship Committee

_
Infection Control Committee (ICC)

_
Pharmacy and Therapeutics Committee (PTC)
_
Others (please specify):
*Requestfor the organizationalstructure ofthe AMS program within thefacility. The AMS Committee may be independent or
lodged with either the ICC or the PTC.
3. Are the roles and responsibilities of the hospital staff involved in the stewardship-related activities stated in the policy?

_ why not?
Yes

4. Is _ a trained team at your hospital?

there
No,
AMS

_ why not?
Yes

_No,
*Note: The 'AMS team’ must be composed ofmore than one staffmember who supports clinical decisions to ensure appropriate
antimicrobial use.
5. Is there a physician identified as a leader for AMS activities at your hospital?
__No
Yes, who leads?

6. Are there sufficient funding and resources for AMS-related activities in your hospital?

_ Yes

If _ No
yes, how much?
If no, what resources are lacking?
7. Is there an IT system being utilized to support AMS-related activities in your hospital?

_
Yes

_
No
/
If yes, please identify the software 5 being used by your hospital:

9° Kindly list the challenges encountered by your hospital in establishing the AMS program.

B. Policy, Guidelines and Clinical Pathways

9. Does your hospital implement an antibiotic policy to promote rational antimicrobial prescribing and dispensing practices?
__ Yes ,
__ N0
*Ifyes, requestfor a copy of the policy. {LL /\/
{
10. Does your hospital keep a soft and hard (if downloaded) copy of the National Antibiotic Guidelines?
Yes
_
1 1.
No
_
Does your hospital have facility-specific treatment recommendations based on local antimicrobial susceptibility to assist with
antimicrobial selection for common clinical conditions?
___ Yes
No
12. Does your hospital follow clinical pathway/s in treating infections and syndromes?
Yes
_
If yes,_please identify the infections and syndromes being addressed by these clinical pathways:
No

13. Does the facility have an approved hospital formulary list?

_Yes
_ why not?N 0,
yes, requestfor a copy of the hospitalformulary
*If list.
C. Antimicrobial Use and Antimicrobial Resistance Surveillance
14. Has your facility produced an antibiogram in the past year?

_ Yes

Who _
No
15. interprets your hospital antibiogram?
16. Is the antibiogram accessible to all healthcare staff?
_ Yes

17. Is _ a platform for the monitoring of antimicrobial use

there
No
(AMU) in your hospital?

_ Yes

If yes,_please identify the tool being used for

No
surveillance:
AMU
18. Is there a pharmacist responsible for ensuring appropriate antimicrobial use at your facility?
___ Yes
No
19. Does your hospital conduct analysis of the antibiogram and AMU data?
_Yes
_ No
If yes, please describe the methodologyof analysis: (Does the hospital correlate the laboratory data on resistant pathogens with
AMU?)

20. Do you impose restricted antimicrobial list?

_Yes
D. Action _ N 0, why not?

21. Which of the following AMS interventions does your hospital implement? Check all applicable:
_
Antimicrobial restriction and pre-authorization

_
Seventh day automatic stop order

_
Dose optimization

_
Streamlining or de—escalation of antimicrobial therapy
_
lV-to-PO antimicrobial therapy switch

_
Audit and Feedback

_
Others, please specify:
22. Does your facility have a written policy that requires prescribers to document an indication in the medical record or during
order entry for all antimicrobial prescriptions?
_Yes
_
No, why not?
*Ifyes, requestfor a copy of the policy.
23. Is it routine practice for specified antimicrobial agents to be approved by a physician prior to use in your hospital?
Yes
_No j

Page 2 of3 Kb g ,7
24. Is there a formal procedure for a physician, pharmacist, or other staffmember to review the appropriateness of an
antimicrobialwithin or after 48 hours from the initial order?
_Yes
__ No
25. Does your hospital monitor if the indication is captured in the medical record for all antimicrobial prescriptions?

_ Yes

_results of antimicrobial audits or reviews communicated regularly with prescribers?

26. Are the
No

_ how regular?
Yes,
No
.

27. Does your hospital conduct AMS-related trainings and seminars to all Its staff?
_Yes
_ No
28. Does your hospital promote collaboration among its healthcare professionals?

_ Yes

29. Does _
No
your hospital organize activities that will strengthen the knowledge of the patients and caregivers in on rational use of
antimicrobials?
_ Yes

30. _of the following does your hospital use to disseminate AMS-related informationwithin the facility? Please check and
Which
No

describe all applicable:

_ Posters
_ Newsletters
___ Television
Leaflets / pamphlets

F. _ Others,Evaluation
Performance
please specify:

31. How often does your hospital evaluate its AMS programs?

_Annually
_ Quarterly
Biannually
_ Others, please specify:
32. Have_
you developed an annual report on antimicrobial stewardship in the past year?
Yes

_ No

NOTES:

Name of Interviewer and Designation Name of Interviewee and Designation

Time finished:

Page 3 of 3
AWN“
 ANNEX B
Requirements and Timeline of Implementation of AMS Program
by Level of Healthcare Facility

|
AlVlS Team 4 AMS Team + i
AMS Team”;
AMS/ AMS/ AMS/
1
' Leadershi p :

ICC Committee: ICC Committee: ‘;

ICC Committee;
'
2020 2018 i

2018
'

"Policy — 2019 “pansy — 2018 : Petey — 2018'

2‘ Policy, Guidelines and Clinical
Guidelines and Guidelines and Guidelines and
'

Pathways
Pathways - 2020 Pathways - 2019 ,

Pathways - 2019
AMU surveillance iAMU surveillance
1

AMU
- 2019 - 2018
‘

3' Surveillance OfAMU and AMR

. .
surveillance- AMR surveillance i

AMR surveillance
202°
,

- 2019 - 2019
4. Action:
Restriction and Pre—authorization .
2020 ' 2018 2018

4. Action:
' 3

2020 2018 2018

Seventh Day Automatic Stop Order
4. Action: 2019
Point-Of-Care interventions NA*
,
2019

4. Action:
Audit-and—feedback
NA* 2022 .
2022

5. Education 2019 2018 2018

6. Performance Evaluation 2022 2022 2022
AMS Training Implementation 2019-2020 2018 2017
Full implementation of AMS Program
in the hospital Jan 2022 Jan 2022 Jan 2022
First performance evaluation report
to be submitted to DOH Jan 2021 Jan 2019 Jan 2018

i In the absence of an AMS committee, the AMS team may report to the ICC committee or any
other formal hospital bodies with shared interest In antimicrobial use and resistance.
*
Level l healthcare facilities are encouraged to implement these actions if capability permits.