Antimicrobial Stewardship Intervention Note

Date/Time of Review: [Timestamp]

Author: [Name, credentials, role (e.g., ASP Pharmacist, ID Physician, APP)]

Service: Antimicrobial Stewardship Program

Patient Location: [Unit/Service]

Method of Review: [Chart review only / Chart review + bedside assessment]

Reason for Review

[Trigger for stewardship review (e.g., prospective audit, restricted agent authorization, culture-driven review, 48-72h antibiotic time-out, duration review, IV-to-PO screen, discharge planning) and antimicrobial(s) under evaluation; 1–2 clinical questions being addressed]

Current Antimicrobial Therapy

(List systemic antimicrobials currently prescribed or under active review. Include recently discontinued agents only if relevant to spectrum decisions or total duration calculations.)

• [Agent name] — [dose/route/frequency]; started [date]; Day [#]; Indication: [documented indication / unclear]; Duration: [planned duration/stop date if ordered]; [renal dosing context if relevant]
• (Add additional agents as needed.)

Clinical Context & Microbiology

[Brief clinical synopsis: suspected or confirmed infection/syndrome; diagnostic certainty (confirmed/probable/rule-out); key host factors influencing therapy (immunocompromise, sepsis/shock, hardware, recent antibiotics); source control status if relevant]

[Pertinent microbiology: culture site(s), collection date(s), and results (organism with susceptibilities / no growth to date / pending); relevant rapid diagnostics (MRSA PCR, respiratory panel); note if cultures not obtained when typically expected]

Stewardship Assessment

(Address only domains relevant to this review. Omit domains where therapy is already optimized. Document explicitly when missing information affects recommendations.)

• Need: [Assessment of whether evidence supports bacterial infection requiring antibiotics; note diagnostic uncertainty or possible noninfectious etiology]
• Spectrum: [Guideline-concordance; coverage gaps or unnecessary breadth (redundant anaerobic, unnecessary anti-MRSA or anti-pseudomonal); de-escalation opportunities based on cultures or clinical stability]
• Dose: [Renal/hepatic or weight-based adjustments; therapeutic drug monitoring indication and status]
• Route: [IV-to-PO conversion eligibility (hemodynamically stable, tolerating PO, clinically improving, suitable oral option available) or specific limiting factor]
• Duration: [Appropriate total duration; counting start point (e.g., from source control, first negative blood culture); risk of excessive duration on current trajectory]
• Safety: [Relevant risks: C. difficile, nephrotoxicity, drug interactions, allergy concerns]
• Overall: [If current therapy is appropriate with no changes recommended, state explicitly with brief rationale] (Include only when no changes are recommended.)

Recommendations

Summary: [One-sentence summary of recommended actions]

1. [Specific action: stop / change / narrow / convert IV-to-PO / set stop date] — [One-sentence clinical rationale]. Timing: [today / after cultures finalize / when tolerating PO].
2. (Add additional recommendations as needed.)

(When recommending duration, include:)

• Total Duration: [Number of days]
• Stop Date: [Specific date/time]
• Reassessment: [Checkpoint or trigger for review, if applicable]

(If clarification from the primary team is needed:)

• [Specific clarification question(s)]

Communication & Follow-up

• Communication: [Date/time]; [Recipient name/role]; [Method: in-person / phone / EHR message / during rounds]; [Outcome: accepted / declined with reason / pending]. (If unable to reach team, note attempts and follow-up plan.)
• Monitoring: [Clinical endpoints to follow (fever, hemodynamics, WBC)]; [Laboratory monitoring (renal function, drug levels)]
• Next Stewardship Review: [Planned date or conditions prompting reassessment]
• Discharge Plan: [Planned outpatient regimen; total duration inclusive of inpatient days; stop date; follow-up labs/appointments] (Include only if discharge is imminent with planned outpatient antibiotics.)

— [Author name], [Credentials], [Role]

Recommendations provided by Antimicrobial Stewardship Program; prescribing team retains ordering responsibility.