0920-1282 Form 2 - HAI/AR Performance Measures (SHARP Project III;

HAI/AR Performance Measures (SHARP Project III; Stewardship), 2022-2023
Page 1

SHARP PM 3.1 Description of Staff Leading Antibiotic
Stewardship Activities
Recipient

__________________________________

SHARP Project III Stewardship Performance Measures - Measure 1 Instructions: Complete the form below. Once
complete mark as 'Complete' and select 'Save & Go to Next Form' from the drop down below.
To see complete list of all questions and answer choices, download the PDF attachment
[Attachment: "Performance Measures_2022_2023.pdf"]

Measure 1: Description of Staff Leading and Supporting Antibiotic Stewardship Activities
Jurisdiction has identified an antibiotic stewardship
lead or co-lead to develop, implement and evaluate
stewardship activities and provide expertise to
healthcare settings with limited access to stewardship
resources.
If No, please provide status update or challenges
encountered in identifying or hiring a lead:

Yes
No

__________________________________________

If Yes, answer the following:
1. On average, how many hours per week does the
stewardship lead/co-leads (combined) work on
antibiotic stewardship for the health department?

0-19 hours
20-39 hours
40+ hours

2. Stewardship lead/co-leads are:

Physician
Pharmacist
Other (e.g., nurse/nurse practitioner,
epidemiologist, etc.)

Check all that apply

Check if applies

Completed a fellowship in infectious diseases
Completed a certificate program or training course
on antibiotic stewardship
Has experience implementing stewardship in a
clinical setting
None of the above

Check if applies

Completed the PGY2 residency and/or a residency in
infectious diseases
Completed a certificate program or training course
on antibiotic stewardship
Has experience implementing stewardship in a
clinical setting
None of the above

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If other, please specify: ______
Check if applies

Staffing Directory is updated with required
information for all staff leading and supporting
antibiotic stewardship activities:

Completed an antibiotic stewardship certificate
program or training course on antibiotic
stewardship
Has experience implementing stewardship in a
clinical or public health setting
None of the above
Yes
No

If No, please update the HAI/AR Program Staffing Directory.

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HAI/AR Performance Measures (SHARP Project III; Stewardship), 2022-2023
Page 3

SHARP PM 3.2 Implementation of Antibiotic Stewardship
Activities
SHARP Project III Stewardship Performance Measures - Measure 2   

Purpose: The purpose of this measure is to capture details on all Stewardship activities planned and/or implemented
during this reporting period (August 1st, 2022 - July 31st, 2023). 

INSTRUCTIONS: One form should be completed for EACH activity. To add a NEW stewardship activity in REDCap click
"Save and Add New Instance."
This form will only ask about the details of a single stewardship activity. Please fill out another form to report on an
additional stewardship activity (e.g., if your jurisdiction is engaged in three stewardship activities, submit Measure 2
three times, once for each activity). 
To see complete list of all questions and answer choices, download the PDF attachment
[Attachment: "Performance Measures_2022_2023.pdf"]

Measure 2: Implementation of Antibiotic Stewardship Activities
Title of Activity:

__________________________________

Summary of activity (up to 300 words):
Please provide a brief summary of the activity.
Include any key actions, data sources, partners,
outcomes, timelines, and personnel involved. 
Stage of implementation of activity:
Planning: activity has not yet been initiated or
implemented Ongoing: activity is actively being
implemented Completed: activity has been completed
Evaluation: activity has been completed and is being
evaluated for impact

__________________________________________

Planning
Ongoing
Completed
Evaluation

Health equity-related considerations are part of the
activity:

Yes
No

Healthcare setting where activity is implemented:

Outpatient Setting
Acute Care Setting
Long-term Care Setting
Other Setting

If activity is across multiple settings, select more
than one setting.
If Yes, please specify (up to 150 words):

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Outpatient Setting:
Type of Outpatient Setting: (Check all that apply)

If Other, please specify:

Acute Care Setting:
Type of Acute Care Setting: (Check all that apply)

If Other, please specify:

Long-Term Care Setting:
Type of Long-Term Care Setting: (Check all that
apply)

If Other, please specify:

Other Setting:
Type of Other Setting: (Check all that apply)

If Other, please specify:

Primary care clinic
Outpatient specialty and subspecialty
Emergency department
Retail health clinic
Urgent care clinic
Other

__________________________________
General acute care hospital
Critical access hospital
Children's hospital
Long-term acute care hospital
Other

__________________________________
Nursing home
Skilled-nursing facility
Ventilator skilled-nursing facility
Assisted living facility
Other

__________________________________
Dialysis facility
Dental setting
One Health Collaborative
Telehealth
Ambulatory surgical center
Other

__________________________________

Measure 2.1 Outpatient Setting

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Select the category that describes the activity:
Assessment of Antibiotic Stewardship Implementation:
Identify healthcare professionals or settings where
improving antibiotic use and enhancing Core Elements
of antibiotic stewardship uptake is needed Antibiotic
Use Tracking & Reporting: Monitor antibiotic
prescribing. Measuring antibiotic use is critical to
identify variability in antibiotic use and to assess,
support and improve stewardship interventions
Antibiotic Stewardship Action & Collaboration:
Implement evidence-based, local-level stewardship
activities with partners or in the setting of a
stewardship collaborative Antibiotic Stewardship
Education & Communication: Engage with healthcare
professionals, patients and the public to optimize
antibiotic use, and inform guidelines and policies to
strengthen stewardship practice (Check all that
apply)
Assessment of Antibiotic Stewardship Implementation
(Identify healthcare professionals or settings where
improving antibiotic use and enhancing Core Elements
of antibiotic stewardship uptake is needed)
Select the element(s) used to identify healthcare
professionals or settings.

Assessment of Antibiotic Stewardship Implementation
Antibiotic Use Tracking & Reporting
Antibiotic Stewardship Action & Collaboration
Antibiotic Stewardship Education & Communication

High or inappropriate antibiotic prescribing rates
or priority conditions
MDRO outbreak
Limited access to antibiotic stewardship
expertise, staffing, and/or resources

The list is not inclusive of all elements; you may
include other elements not listed here in the Summary
of Activity section above.
(Check all that apply)
Antibiotic Use Tracking & Reporting (Monitor
antibiotic prescribing. Measuring antibiotic use is
critical to identify variability in antibiotic use and
to assess, support and improve stewardship
interventions)
Select the element(s) part of the activity.
The list is not inclusive of all elements; you may
include other elements not listed here in the Summary
of Activity section above.

Commercial/proprietary data (e.g., IQVIA)
CMS data (e.g., Medicaid data, Medicare public use
files)
All Payer Claims data
HEDIS measures
Antibiotic use reporting dashboard
Activity measures or collects health equity
related data elements (e.g., patient or clinician
characteristics, geography, setting of care)

(Check all that apply)
Antibiotic Stewardship Action & Collaboration
(Implement evidence-based, local-level stewardship
activities with partners or in the setting of a
stewardship collaborative)   

Electronic health record-based interventions
Feedback letters or emails

Select the element(s) part of the activity.
The list is not inclusive of all elements; you may
include other elements not listed here in the Summary
of Activity section above.
(Check all that apply)

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Antibiotic Stewardship Education &
Communication (Engage with healthcare professionals,
patients and the public to optimize antibiotic use,
and inform guidelines and policies to strengthen
stewardship practice)  
Select the element(s) part of the activity.
The list is not inclusive of all elements; you may
include other elements not listed here in the Summary
of Activity section above.

Plan and participate in US Antibiotic Awareness
Week promotional activities
Support a jurisdiction-wide stewardship
educational activity (e.g., workshop, conference,
or summit)
Provide facility-specific antibiotic stewardship
mentorship and support (virtual or in-person) to
outpatient settings with limited access to
antibiotic stewardship expertise (e.g., rural
facilities)

(Check all that apply)
Number of outpatient facilities engaged:
(Enter 0 if no facilities engaged)
Number of outpatient healthcare professionals engaged:
(Enter 0 if no healthcare professionals engaged)
Type of partner(s) engaged:
(Check all that apply)

If Other, please describe:

__________________________________

__________________________________

Healthcare system
Payer
Academic partner
Other state or local health department
Multi-state collaborative
Regulatory/licensing agency
Local or national professional organization
HIINS or QIN/QIOs
Other
None

__________________________________

Measure 2.2 Acute Care Setting
Select the category that describes the activity:
Assessment of Antibiotic Stewardship Implementation:
Identify healthcare professionals or settings where
improving antibiotic use and enhancing Core Elements
of antibiotic stewardship uptake is needed Antibiotic
Use Tracking & Reporting: Monitor antibiotic
prescribing. Measuring antibiotic use is critical to
assess, support and improve stewardship interventions,
and identify variability in antibiotic use Antibiotic
Stewardship Action & Collaboration: Implement
evidence-based, local-level stewardship activities
with partners or in the setting of a stewardship
collaborative Antibiotic Stewardship Education &
Communication: Engage with healthcare professionals,
patients and the public to optimize antibiotic use,
and inform guidelines and policies to strengthen
stewardship practice (Check all that apply)

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Assessment of Antibiotic Stewardship Implementation
Antibiotic Use Tracking & Reporting
Antibiotic Stewardship Action & Collaboration
Antibiotic Stewardship Education & Communication

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Assessment of Antibiotic Stewardship Implementation
(Identify healthcare professionals or settings where
improving antibiotic use and enhancing Core Elements
of antibiotic stewardship uptake is needed)
Select the element(s) used to identify healthcare
professional or settings.

Not meeting Core Elements on National Healthcare
Safety Network (NHSN) annual hospital survey
NHSN AU Option outlier
MDRO outbreak/Infection Control Assessment (ICAR)
Limited access to antibiotic stewardship
expertise, staffing, and/or resources

The list is not inclusive of all elements; you may
include other elements not listed here in the Summary
of Activity section above.
(Check all that apply)
Antibiotic Use Tracking & Reporting (Monitor
antibiotic prescribing. Measuring antibiotic use is
critical to assess, support and improve stewardship
interventions, and identify variability in antibiotic
use)

Support NHSN AU Option enrollment
Activity measures or collects health equity
related data elements (e.g., patient or clinician
characteristics, geography, setting of care)

Select the element(s) part of the activity.
The list is not inclusive of all elements; you may
include other elements not listed here in the Summary
of Activity section above.
(Check all that apply)
Antibiotic Stewardship Action & Collaboration
(Implement evidence-based, local-level stewardship
activities with partners or in the setting of a
stewardship collaborative)   
Select the element(s) part of the activity.

Leverage NHSN AU Option Standardized Antimicrobial
Administration Ratio (SAAR) metrics to inform
where to focus improvement activities
Create facility certificates (e.g., honor roll) to
acknowledge success based on the implementation of
advanced stewardship criteria

The list is not inclusive of all elements; you may
include other elements not listed here in the Summary
of Activity section above.
(Check all that apply)
Antibiotic Stewardship Education &
Communication (Engage with healthcare professionals,
patients and the public to optimize antibiotic use,
and inform guidelines and policies to strengthen
stewardship practice) 
Select the element(s) part of the activity.
The list is not inclusive of all elements; you may
include other elements not listed here in the Summary
of Activity section above.

Plan and participate in US Antibiotic Awareness
Week promotional activities
Support a jurisdiction-wide stewardship
educational activity (e.g., workshop, conference,
or summit)
Provide facility-specific antibiotic stewardship
mentorship and support (virtual or in-person) to
acute care settings with limited access to
antibiotic stewardship expertise (e.g., rural
facilities)

(Check all that apply):

Number of outpatient facilities engaged:
(Enter 0 if no facilities engaged)

__________________________________

Number of outpatient healthcare professionals engaged:
(Enter 0 if no healthcare professionals engaged)

__________________________________

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Type of partner(s) engaged:
(Check all that apply)

If Other, please describe:

Healthcare system
Payer
Academic partner
Other state or local health department
Multi-state collaborative
Local health department
Regulatory/licensing agency
Local or national professional organization
HIINS or QIN/QIOs
Other
None

__________________________________

Measure 2.3 Long-Term Care Setting
Select the category that describes the activity:
Assessment of Antibiotic Stewardship Implementation:
Identify healthcare professionals or settings where
improving antibiotic use and enhancing Core Elements
of antibiotic stewardship uptake is needed Antibiotic
Use Tracking & Reporting: Monitor antibiotic
prescribing. Measuring antibiotic use is critical to
assess, support and improve stewardship interventions,
and identify variability in antibiotic use Antibiotic
Stewardship Action & Collaboration: Implement
evidence-based, local-level stewardship activities
with partners or in the setting of a stewardship
collaborative Antibiotic Stewardship Education &
Communication: Engage with healthcare professionals,
patients and the public to optimize antibiotic use,
and inform guidelines and policies to strengthen
stewardship practice (Check all that apply)
Assessment of Antibiotic Stewardship
Implementation (Identify healthcare professionals or
settings where improving antibiotic use and enhancing
Core Elements of antibiotic stewardship uptake is
needed)
Select the element(s) used to identify healthcare
professional or settings.

Assessment of Antibiotic Stewardship Implementation
Antibiotic Use Tracking & Reporting
Antibiotic Stewardship Action & Collaboration
Antibiotic Stewardship Education & Communication

Not meeting Core Elements on National Healthcare
Safety Network (NHSN) annual facility survey
CMS stewardship citation
High or inappropriate antibiotic prescribing rates
or priority conditions
MDRO outbreak/Infection Control Assessment (ICAR)
Limited access to antibiotic stewardship
expertise, staffing, and/or resources

The list is not inclusive of all elements; you may
include other elements not listed here in the Summary
of Activity section above.
(Check all that apply)

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Antibiotic Use Tracking & Reporting (Monitor
antibiotic prescribing. Measuring antibiotic use is
critical to assess, support and improve stewardship
interventions, and identify variability in antibiotic
use)
Select the element(s) part of the activity.

Support collaboratives and partnerships to use
long-term care pharmacy or electronic health
record data to track and report facility-level AU
Activity measures or collects health equity
related data elements (e.g., patient or clinician
characteristics, geography, setting of care)

The list is not inclusive of all elements; you may
include other elements not listed here in the Summary
of Activity section above.
(Check all that apply)
Antibiotic Stewardship Action & Collaboration
(Implement evidence-based, local-level stewardship
activities with partners or in the setting of a
stewardship collaborative)   
Select the element(s) part of the activity.

Support collaboratives that implement activities
to improve AU such as electronic health
record-based stewardship interventions
Create facility certificates (e.g., honor roll) to
acknowledge success based on the implementation of
activities outlined in the core elements checklist

The list is not inclusive of all elements; you may
include other elements not listed here in the Summary
of Activity section above.
(Check all that apply)
Antibiotic Stewardship Education &
Communication (Engage with healthcare professionals,
patients and the public to optimize antibiotic use,
and inform guidelines and policies to strengthen
stewardship practice) 
Select the element(s) part of the activity.
The list is not inclusive of all elements; you may
include other elements not listed here in the Summary
of Activity section above.

Plan and participate in US Antibiotic Awareness
Week promotional activities
Support a jurisdiction-wide stewardship
educational activity (e.g., workshop, conference,
or summit)
Provide facility-specific antibiotic stewardship
mentorship and support (virtual or in-person) to
long-term care settings with limited access to
antibiotic stewardship expertise (e.g., rural
facilities)

(Check all that apply)
Number of outpatient facilities engaged:
(Enter 0 if no facilities engaged)

__________________________________

Number of outpatient healthcare professionals engaged:
(Enter 0 if no healthcare professionals engaged)

__________________________________

Type of partner(s) engaged:
(Check all that apply)

If Other, please describe:

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Healthcare system
Payer
Academic partner
Other state or local health department
Multi-state collaborative
Local health department
Regulatory/licensing agency
Local or national professional organization
HIINS or QIN/QIOs
Other
None

__________________________________

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Measure 2.4 Other Setting
Select the category that describes the activity:
Assessment of Antibiotic Stewardship Implementation:
Identify healthcare professionals or settings where
improving antibiotic use and enhancing Core Elements
of antibiotic stewardship uptake is needed Antibiotic
Use Tracking & Reporting: Monitor antibiotic
prescribing. Measuring antibiotic use is critical to
to assess, support and improve stewardship
interventions, and identify variability in antibiotic
use Antibiotic Stewardship Action & Collaboration:
Implement evidence-based, local-level stewardship
activities with partners or in the setting of a
stewardship collaborative Antibiotic Stewardship
Education & Communication: Engage with healthcare
professionals, patients and the public to optimize
antibiotic use, and inform guidelines and policies to
strengthen stewardship practice (Check all that
apply)
Assessment of Antibiotic Stewardship
Implementation (Identify healthcare professionals or
settings where improving antibiotic use and enhancing
Core Elements of antibiotic stewardship uptake is
needed)

Assessment of Antibiotic Stewardship Implementation
Antibiotic Use Tracking & Reporting
Antibiotic Stewardship Action & Collaboration
Antibiotic Stewardship Education & Communication

High or inappropriate antibiotic prescribing rates
or priority conditions
MDRO outbreak/Infection Control Assessment (ICAR)
Limited access to antibiotic stewardship
expertise, staffing, and/or resources

Select the element(s) used to identify healthcare
professional or settings.
The list is not inclusive of all elements; you may
include other elements not listed here in the Summary
of Activity section above.
(Check all that apply)
Antibiotic Use Tracking & Reporting (Monitor
antibiotic prescribing. Measuring antibiotic use is
critical to to assess, support and improve stewardship
interventions, and identify variability in antibiotic
use)

Support collaboratives and partnerships to track
and report facility-level AU
Activity measures or collects health equity
related data elements (e.g., patient or clinician
characteristics, geography, setting of care)

Select the element(s) part of the activity.
The list is not inclusive of all elements; you may
include other elements not listed here in the Summary
of Activity section above.
(Check all that apply)

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Antibiotic Stewardship Action & Collaboration
(Implement evidence-based, local-level stewardship
activities with partners or in the setting of a
stewardship collaborative)   
Select the element(s) part of the activity.
The list is not inclusive of all elements; you may
include other elements not listed here in the Summary
of Activity section above.

Feedback letters or emails
Support collaboratives that implement activities
to improve AU such as electronic health
record-based stewardship interventions
Create facility certificates (e.g., honor roll) to
acknowledge success based on the implementation of
stewardship activities

(Check all that apply)
Antibiotic Stewardship Education &
Communication (Engage with healthcare professionals,
patients and the public to optimize antibiotic use,
and inform guidelines and policies to strengthen
stewardship practice) 
Select the element(s) part of the activity.
The list is not inclusive of all elements; you may
include other elements not listed here in the Summary
of Activity section above.

Plan and participate in US Antibiotic Awareness
Week promotional activities
Support a jurisdiction-wide stewardship
educational activity (e.g., workshop, conference,
or summit)
Provide antibiotic stewardship mentorship and
support (virtual or in-person) to settings with
limited access to antibiotic stewardship expertise
(E.g., rural facilities)

(Check all that apply)
Number of outpatient facilities engaged:
(Enter 0 if no facilities engaged)
Number of outpatient healthcare professionals engaged:
(Enter 0 if no healthcare professionals engaged)
Type of partner(s) engaged:
(Check all that apply)

If Other, please describe:

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__________________________________

__________________________________

Healthcare system
Payer
Academic partner
Other state or local health department
Multi-state collaborative
Local health department
Regulatory/licensing agency
Local or national professional organization
HIINS or QIN/QIOs
Other
None

__________________________________

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Pending - SHARP PM 3 Antibiotic Stewardship Data Close
Out
Please complete the survey below.
Thank you!

Antibiotic Stewardship: Data Closeout 

Errors identified during submission:

Yes
No

Performance Measure Flagged for Follow-up Summary of Issues Please confirm that the issue has been addressed:
PM 1: Description of Staff Leading and Supporting Antibiotic Stewardship Activities ______ ______ ______
PM 2: Implementation of Antibiotic Stewardship Activities ______ ______ ______
PM 2: Number of Antibiotic Stewardship Activities ______ ______ ______
Notes/comments to CDC:

Thank you for submitting your Antibiotic Stewardship Performance Measures. No items have been flagged for
follow-up.

If you have any questions, concerns, or issues with the items indicated above please contact [email protected]
with "Antiobiotic Use Performance Measures - Data Closeout" in the subject line.

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