A live, team-based stewardship game. Draft a bench of antibiotics, then treat real cases on your phone while the story plays out on the big screen. The team that treats smartest — not broadest — wins.
Every case is a tug-of-war: pick something that covers the infection, but stay as narrow, cheap, and low-risk as the situation allows. Points reward the right call at the right level of care — and quietly dock you for overkill, cost, and C. diff.
Formulary runs across three views at once. You only need your phone.
The Board
On the projector — the shared story: the patient, the cultures, the reveal, the standings. Everyone watches this.
/formulary/boardYour Phone
Your team's console. One player is the Captain and submits for the team; everyone else follows along.
/formulary/playThe Host
A facilitator opens cases, advances the days, and reveals scoring. They keep the game moving.
/formulary/hostThe board shows a QR code and a short room code. Point your camera at it (or go to the URL and type the code) to hop in.
- Enter your name, then choose your team.
- The first person on a team becomes the Captain — the one whose picks count. The host can reassign this anytime.
- Team chips light up on the board as people join.
Before the cases start, draft the antibiotics your team can use. You draft for both benches — an 💉 IV bench and a 💊 PO (oral) bench.
- One shared budget covers both benches. There's no limit on how many you take — price is the cap.
- Draft to cover the field: the checklist shows which roles you've filled (gram-negative, MRSA, anaerobes…).
- The Captain taps Lock in roster when ready. You can only play an antibiotic you drafted.
Draft — Cipro Crew
During the draft the board shows your hospital's local antibiogram — how well each drug covers each bug. Draft to the field you'll face.
- Numbers = local %S (percent susceptible). Letters are the Sanford grade: ++ reliably active, + ~90%, ± variable, 0 inactive.
- The core rule: a drug covers if the case's roll ≤ its %S. Higher %S = safer bet.
- Greener cells = better coverage; red = don't count on it.
Local antibiogram
draft to cover the fieldThe board sets the scene: the syndrome, the vignette, and a timeline of days. The green, current day is the decision you're making right now.
- Cases unfold over several days — an empiric first move, then follow-ups as data returns.
- The setting (outpatient vs inpatient) and any flags (pregnant, neutropenic) change what's safe.
- Read it, then make your call on your phone.
On your phone the Captain makes two choices: where the patient goes (the sticky box at top) and what to give (the drug list).
- Tap agents to build the regimen — each shows its route, per-day price, and C. diff risk dots.
- Picks auto-save. The green bar confirms what's submitted. Change it anytime before the host advances.
- No infection to treat? Tap 🚫 No antibiotics — sometimes the right answer is to withhold.
Picking the drug is only half of it. Where the patient goes — discharge, admit, floor, or ICU — is scored on its own.
- Under-triage (too little care for a sick patient) hurts more than over-triage (too cautious).
- You can't discharge on an IV-only drug — there's no way to finish the course at home. The game flags it: "cannot complete outpatient course."
- The box pulses red until you choose, then locks green.
Day 0 is a blind bet — susceptibilities are pending. On a later day the culture comes back and the board reveals the susceptibility roll: one number, checked against each drug's %S.
- A drug is susceptible if the roll lands in its green zone (roll ≤ %S), resistant if it overshoots.
- Now de-escalate: switch to the narrowest agent that still covers.
- On your phone, pills you drafted get a ✓ covers / ✗ resistant tag so you can pick with confidence.
At the end of each case, every day is scored and the board shows the full breakdown. The core clinical tiers:
- Narrowest effective ✓ — biggest reward. Covers-but-not-guideline-preferred = fewer points (off-guidelines).
- Antibiogram-concordant ✓ — a bonus when your pick matches both the guideline and the local antibiogram.
- Off-antibiogram — guideline-concordant, but our local data doesn't back it: no penalty, you just don't earn the bonus.
- Suboptimal — effective but not the preferred choice here (e.g. right drug, wrong route): a small ding.
- Overbroad — it worked, but it was overkill: a stewardship ding.
- Inadequate — didn't cover the bug: the big miss.
- Disposition — right level of care adds; under/over-triage subtracts.
Broad, long, expensive therapy doesn't just cost points directly — it comes back to bite you.
- Cost accrues per day of therapy — cheaper regimens keep more points.
- Every case rolls for C. diff at the end. The broader and longer you treated, the bigger the red zone — and a hit costs you.
- Get hit and the whole board knows it: the screen does the 💩 flush.
After the last case, the board tallies everything up. Your total score is:
clinical points − cost − C. diff hits
- Highest total wins — but there are superlatives too: De-escalation champ, Sharpest empiric, Best stewardship, Thriftiest draft.
- Carpet-bombing every case can still lose to a team that treated narrow, cheap, and clean.
Standings — by total score
Superlatives
Grab your phone, scan the code on the board, pick a team — and treat smart.