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Antimicrobial Stewardship in Outpatient Settings

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Welcome to our antimicrobial stewardship (AMS) resources page.  Here we provide content to help practices involved in our AMS in Outpatient Settings Initiative (and others) improve their programs’ efforts to meet CDC’s Core Elements of Outpatient Antibiotic Stewardship.  Each resource is laid out by which Core Element it helps accomplish.

Keep an eye on this page as we add more resources as the initiative matures (through mid-2019).




The following resources are across all four elements.

  • A Field Guide to Antibiotic Stewardship in Outpatient Settings : Review interventions collected by QIN/QIOs nationally based on our outpatient AMS core element promotion work.
  • The MITIGATE toolkit for Emergency Departments and Urgent Care settings was written by several AMS experts and supported by the Center for Disease Control and Prevention. Though it has a focus on Emergency and Urgent Care settings, much of the information is generalizable to other ambulatory settings. This guide uses the four core elements as a structure for program implementation. This document includes a list of all ICD 10 codes for infections that may be useful to report development or identification of visits for audit (p 18-22).  In addition, the authors suggest interview and survey questions to assess the current provider knowledge level and attitudes toward antibiotic prescribing. These questions can be good tools to help you identify topics for education and also to evaluate your staff’s attitude toward AMS.
  • The Washington State Department of Health has developed an over-arching guidance workbook to “jump starting” implementation of your AMS Program. This document provides guidance and tools to plan, implement and maintain a feasible, sustainable antimicrobial stewardship program, tailored to your setting’s own resources and characteristics. This workbook, and all of WADOH’s AMS resources align with the CDC Core Elements of Outpatient Antimicrobial Stewardship.




Printable Public Displays of Leadership Commitment to AMS

  • Qualis Health, and our states’ partners in quality healthcare and public health, have adapted published and CDC materials to provide these state-specific posters for your practice waiting rooms.

Note – these files are sized for printing at the dimensions above, but can be printed “scale to fit” to fit a normal 8 ½” x 11" page.

  • Individual/Provider-Specific Commitment to AMS -  Having individual providers publicly display their dedication to appropriate antibiotic prescribing has shown effective behavior change. These posters, intended for exam-rooms, can serve as a reminder to patients and providers about when antibiotics may not be appropriate. These posters were designed with the support of the Washington State Department of Health.



Evidence-Based Diagnostic Criteria and Treatment Recommendations

Viral Prescription Pad




Data Tracking Audits and Worksheets

Qualis Health has developed resources to assist you in aligning your AMS tracking of high priority conditions and prescribing volume with your Merit-based Incentive Payment System (MIPs) projects.

  • UTI Audit Tool
    Download UTI Audit Tool Example
    Download UTI Audit Tool Template

    Here is a new tool to help you track treatment of UTI patients! Review some patient charts and determine how well prescribers are following treatment recommendations for uncomplicated UTI.  This tool will help you identify variation in prescribing among your providers, frequency of treatment of asymptomatic UTI and measure antibiotic appropriateness when culture results become available.

    **TIP** Use this tool to dive into your own data on urinary tract infection prescribing.  Collecting and reporting this data is a great way to engage prescribers by viewing overall trends as well as variation among peers.  According to the CDC, UTI is a common diagnosis resulting in antibiotic prescriptions in outpatient settings.    Due to the volume of prescriptions, limiting the use of broad spectrum antibiotics for this diagnosis can have an impact on reducing resistance.

  • AMS Tracking and Audit Tool: 2018 QPP MIPS Measures
    Download Audit Tool

    Here is a customizable workbook to meet Tracking and Reporting Core Element activities. Use this tool with monthly summary data  to generate a run chart of your AMS-specific quality measures. The untitled graphs produced can be used for tracking additional measures as well.  Included are performance benchmarks from 2018 MIPs and AMS-related measures. Track your own progress towards organization-specific goals over time.

    More information on MIPs and the Quality Payment Program

    Details on CMS Quality Measures in MIPs
  • AMS Audit and Tracking Tool: Upper Respiratory Infection Prescribing
    View Tool Example Updated November 2018!
    Download Audit Tool Updated November 2018!

    Acute respiratory conditions are the most common diagnoses associated with outpatient antibiotic prescribing.  Many of these infections are viral and require no antibiotics.  Use this chart audit tool to review your prescribing practices (overall and by provider) to compare to current treatment recommendations.  After entering your data, the tool will populate a summary run chart and provider level data.  This data is presented in a document that can be used to report out your progress to leadership and AMS committees.

    If you would like a 508 Compliant copy of either of the above Qualis Health tools, please contact paulap@qualishealth.org in Washington State or marthaj@qualishealth.org in Idaho.
  • The Quality Innovation Network National Coordinating Center (QIN-NCC) developed an audit worksheet for tracking antibiotic prescribing for acute bronchitis and viral upper respiratory infections (URI). These worksheet can help your providers quantify opportunities to improve antibiotic prescribing for this condition. Not only that, improvement in bronchitis treatment and upper respiratory infection treatment will have a positive impact  to your related MIPS and HEDIS measures. Both of these tracking tools can help you answer "How many antibiotics are NOT being prescribed" to evaluate cost savings and risk reduction.
  • A sister Quality Improvement Organization (Telligen) developed a guidebook with condition-specific antibiotic-use measures to assist your clinic track and provide feedback to providers for CMS Quality Measures. Measures include: adult acute bronchitis; adult sinusitis; and acute otitis externa.

State-Specific Overviews of Antibiotic Use in Outpatient Settings

  • Practices working with us in this initiative will be receiving quarterly quality improvement reports on their own antibiotic use information from Medicare data. 




Provider Education - Presentations

  • The CDC Antimicrobial Stewardship Series (through CDC TRAIN) is available on line for CMEs.  This CDC series has added several sections to the educational offerings. Section 2 focuses more specifically on outpatient prescribing. The continuing education credits expire in February, 2020.
  • Here are the goals of the education:
    • Describe the urgency and gravity of antibiotic resistance as a threat to both patient safety and public health.
    • List the benefits of antibiotic stewardship across the healthcare spectrum.
    • Describe the epidemiology of adverse events linked to antibiotic use and their typical patterns of clinical presentation.
    • Apply appropriate antibiotic management methods to improve the quality of pharmaceutical care.
  • The target audience is:Physicians, Physician Assistants, Pharmacists, Advanced Practice Nurses, Registered Nurses, Licensed Practical/Vocational Nurses, Certified Health Educators


  • Additional Continuing Educations credits are also available through this CDC site for:
    • Medical Students (An Antibiotic Stewardship Curriculum for Medical Students) This curriculum focuses on antibiotic resistance, judicious antibiotic use, and common respiratory tract infections, and is intended for use in U.S. medical schools. It is comprised of didactic lectures, corresponding exam questions, and small group activities with facilitator guides. Didactic lectures are meant for medical students in the pre-clinical years. The small group activities are for students on clinical clerkships.

LINK for CDC series is https://www.cdc.gov/antibiotic-use/community/for-hcp/continuing-education.html

  • The World Health Organization has produced a series of courses on antimicrobial stewardship.  Topics such as Antibiotic Allergies and Acute Infectious Diarrhea are included in this series.  No CME’s are available.


A brief summary of the concepts of Mangione-Smith’s presentation can be found on the DART (Dialogue Around Respiratory IllnessTreatment) website. Note that this work was done at the Seattle Children’s Hospital, but the method can be used in the adult population as well.


  • On August 29, 2018 the National Coordinating Center (NCC) hosted the presentation "Reducing Inappropriate Antibiotic Prescribing in Outpatient Settings Using Behavioral Interventions". This presentation focuses on behavioral interventions for providers to reduce unnecessary antibiotic prescribing, while maintaining patient satisfaction with care. The following nationally recognized speakers provided excellent presentations:
    • Speakers:
      • Katherine Fleming-Dutra, MD, Center for Disease Control and Prevention provides an overview and data update
      • Daniella Meeker, PhD, Keck School of Medicine, University of Southern California discusses her publications on “nudging” providers through public commitment and providing specific feedback.
      • Larissa May, MSPH, MSHS, University of California-Davis describes specifics of antimicrobial stewardship in emergency departments and urgent care settings and reviews the research that resulted in the MITIGATE toolkit.



  • Stanford University, School of Medicine: Archived presentation for CME’s – To Prescribe or not to Prescribe? Antibiotics and Outpatient Infections – Stan Deresinski, MD, FIDSA & Marisa Holubar, MD, MS, Stanford University School of Medicine. Target Audience: Physicians in family practice, primary care, internal medicine, obstetrics and gynecology, emergency medicine, pharmacists, as well as nurse practitioners, physician assistants, and allied health professionals. Estimated time to complete: 105 minutes. *Note – Stanford Online CME’s training videos may encounter errors when accessed using Internet Explorer web browser.  They recommend accessing via Google Chrome or Mozilla FireFox web browsers.

Provider Education - Videos

  • Education on AMS Programs in Emergency Departments:
  • Here is a short humorous video on the challenges of antibitiotic prescribing:  “Antibiotics – Don’t be a jerk”

Provider Education - Printable Resources


Patient Education - Videos


Patient Education - Printable Resources