Purpose: To assess prescribers' perceptions about antimicrobial resistance, including the scope of the problem, antibiotic prescribing practices, and thoughts about antimicrobial stewardship programs. This information should inform implementation strategies and identify education needs.
Source: Developed by Greater New York Health Association/United Health Fund ERASE C. difficile Project team. Based on the AHRQ Hospital Survey on Patient Safety Culture.
Instructions: Have prescribers complete the survey. Consider handing it out and collecting it at a faculty meeting or Grand Rounds where they are already gathered. Tally results for use by the ASP team and clinical educators. Also consider presenting survey results to prescribers to provide feedback about the collective attitudes and perceptions in your facility.
Note: The survey is separate from these instructions so that it may be easily duplicated for use.
ERASE-C. diff. Antimicrobial Stewardship Survey
(This survey is designed to be administered pre- and postintervention and to both intervention and control institutions.)
Please indicate your level of agreement with the following statements about your institution.
Antimicrobial Resistance: Scope of the Problem and Key Contributors
| Statement | Strongly Disagree |
Disagree | Neither | Agree | Strongly Agree |
|---|---|---|---|---|---|
| 1. Antibiotic resistance is a problem in this institution. | ___ | ___ | ___ | ___ | ___ |
| 2. Patient rooms are cleaned according to hospital cleaning protocol once a C. difficile patient has been discharged. | ___ | ___ | ___ | ___ | ___ |
| 3. Adherence to hand hygiene protocols is excellent at this institution. | ___ | ___ | ___ | ___ | ___ |
| 4. Adherence to isolation and contact precautions is excellent at this institution. | ___ | ___ | ___ | ___ | ___ |
| 5. This institution does NOT do enough to control the development of C. difficile. | ___ | ___ | ___ | ___ | ___ |
| 6. This institution provides adequate staff education regarding C. difficile. | ___ | ___ | ___ | ___ | ___ |
| 7. A patient is likely to develop a C. difficile infection during a stay at this institution. | ___ | ___ | ___ | ___ | ___ |
Antibiotic Prescribing Practices
| Statement | Strongly Disagree |
Disagree | Neither | Agree | Strongly Agree |
|---|---|---|---|---|---|
| 1. Microbiology lab results are efficiently communicated to the treating physician. | ___ | ___ | ___ | ___ | ___ |
| 2. I regularly refer to the susceptibility/sensitivity patterns at this institution (e.g., an antibiogram) when prescribing antibiotics. | ___ | ___ | ___ | ___ | ___ |
| 3. If medically appropriate, intravenous antibiotics should be stepped down to an oral alternative after 3 days. | ___ | ___ | ___ | ___ | ___ |
| 4. Restrictions on antibiotics impair my ability to provide good patient care. | ___ | ___ | ___ | ___ | ___ |
| 5. Antibiotics are overused at this institution. | ___ | ___ | ___ | ___ | ___ |
| 6. A majority of patients admitted to this institution will be prescribed at least one antibiotic during their hospital stay. | ___ | ___ | ___ | ___ | ___ |
| 7. Many of my patients receive 5 or more days of antibiotics during their stay at this institution. | ___ | ___ | ___ | ___ | ___ |
| 8. Few of my patients are discharged from this institution on antibiotics. | ___ | ___ | ___ | ___ | ___ |
| 9. When discharged to a nursing home or long-term care facility, most of my patients are on IV antibiotics. | ___ | ___ | ___ | ___ | ___ |
Antimicrobial Stewardship Programs (a formal program that monitors and manages the appropriate use of antibiotics)
| Statement | Strongly Disagree |
Disagree | Neither | Agree | Strongly Agree |
|---|---|---|---|---|---|
| 1. Antimicrobial stewardship programs can improve patient care. | ___ | ___ | ___ | ___ | ___ |
| 2. Antimicrobial stewardship programs reduce the problem of antimicrobial resistance. | ___ | ___ | ___ | ___ | ___ |
| 3. Antimicrobial stewardship programs can affect this institution's C. difficile rates. | ___ | ___ | ___ | ___ | ___ |
| 4. This institution has an effective antimicrobial stewardship program. | ___ | ___ | ___ | ___ | ___ |
| 5. This institution does not provide adequate training on antimicrobial prescribing and use. | ___ | ___ | ___ | ___ | ___ |
| 6. Additional staff education on antimicrobial prescribing is needed. | ___ | ___ | ___ | ___ | ___ |
| 7. Prescribing physicians are the only disciplines who need to understand antimicrobial stewardship. | ___ | ___ | ___ | ___ | ___ |
Background Information
1. What is your primary work area or unit in this health care facility? (Please check ONE answer)
___Many different units/No specific unit
___ Medicine (nonsurgical)
___Surgery
___Obstetrics
___Pediatrics
___Emergency department
___Intensive care unit (any type)
___Psychiatry/mental health
___Rehabilitation
___Pharmacy
___Laboratory
___Radiology
___Anesthesiology
___Other (please specify: ______________________)
2. How long have you worked in this health care facility?
___ Less than 1 year
___ 1 to 5 years
___ 6 to 10 years
___ 11 to 15 years
___ 16 to 20 years
___ 21 years or more
3. What is your staff position in this health care facility?
___ Attending/staff physician
___ Physician assistant
___ Resident physician/Intern
___ Nurse practitioner
___ Fellow
___ Infection control
___ Pharmacist
___ Other (please specify: ______________________)
4. How long have you worked in your current specialty or profession?
___ Less than 1 year
___ 1 to 5 years
___ 6 to 10 years
___ 11 to 15 years
___ 16 to 20 years
___ 21 years or more
