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Ø 4D TOOL: Medication Use Evaluation Template

Purpose: A template for reviewing use patterns, including graphic comparison over time.

Source: S. Brown & B. Ostrowsky, Montefiore Medical Center.

Instructions: This template may be tailored for possible use at your facility; review and adapt as appropriate.

Medication Use Evaluation

Unit/Area: XXX Medical Center (XXX Campus)
Submitted by: Antibiotic Stewardship Program
Title: Oral Azithromycin Utilization Evaluation
Date: XXX

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Indicators: (1) Usage and mean duration of oral azithromycin before and after unrestriction; and (2) whether there is a decrease in quinolone use before and after unrestricting azithromycin.

Plan

Disciplines Involved: Antibiotic Stewardship Program

Monitoring Period: XXX – XXX

Sample Size: XXX patients at Campus and XXX patients at Campus according to SYBASE query listing.

Methodology: Retrospective reviews of antibiotic usage were conducted in patients who received oral azithromycin from XXX to XXX. The total numbers of patients on oral azithromycin, ciprofloxacin, moxifloxacin, and various other antibiotic combinations (i.e., azithromycin plus ceftriaxone, piperacillin/tazobactam, ciprofloxacin, or moxifloxacin) were calculated. Analyses were conducted to determine the usage and mean duration of oral azithromycin before and after unrestriction.

Do

Reports were generated using the SYBASE query listing all patients who received oral azithromycin, ciprofloxacin, moxifloxacin, piperacillin/tazobactam, and ceftriaxone between XX and XX.

Check

  • A total of XXX (nonexclusive) patients were included in this review (Table 1).

Table 1

 MonthMonthMonth
Campus
Mean duration of azithromycin (range), days of therapyX (Y-Z)X (Y-Z)X (Y-Z)
AntibioticsNumber of Patients
Azithromycin POXXXXXX
Moxifloxacin POXXXXXX
Ciprofloxacin POXXXXXX
Campus
Mean duration of azithromycin (range), days of therapyX (1-X)X (1-X)X (1-X)
AntibioticsNumber of Patients
Azithromycin POXXXXXX
Moxifloxacin POXXXXXX
Ciprofloxacin POXXXXXX
Table 2. Azithromycin PO and Ceftriaxone
 MonthMonthMonth
Campus
Number of patientsXXXXXX
Duration of azithromycin (range), days of therapyX (1-X)X (1-X)X (1-X)
Campus
Number of patientsXXXXXX
Duration of azithromycin (range), days of therapyX (1-X)X (1-X)X (1-X)
Table 3. Number of Patients on Azithromycin PO and Moxifloxacin
 MonthMonthMonth
MosesXXXXXX
WeilerXXXXXX
Table 4. Number of Patients on Azithromycin PO and Ciprofloxacin
 MonthMonthMonth
MosesXXXXXX
WeilerXXXXXX
Table 5. Number of Patients on Azithromycin PO and Piperacillin/ tazobactam
 MonthMonthMonth
MosesXXXXXX
WeilerXXXXXX
Figure 1. Comparison of Oral Azithromycin and Quinolone Usage at Campus, Before Unrestriction
Line chart showing use of azithromycin, moxifloxacin, and ciprofloxacin before unrestriction. Azithromycin goes up, moxifloxacin goes down, and ciprofloxacin goes down and then back up.   Line chart showing use of azithromycin, moxifloxacin, and ciprofloxacin before unrestriction. Azithromycin goes up, moxifloxacin goes down, and ciprofloxacin goes down and then back up.
Figure 2. Comparison of Oral Azithromycin and Quinolone Usage at Campus, After Unrestriction
Line chart showing use of azithromycin, moxifloxacin, and ciprofloxacin after unrestriction. Azithromycin goes up, moxifloxacin goes down, and ciprofloxacin goes down.

Act

  • There was a trend of XX oral azithromycin usage comparing XX to XX after unrestriction.
  • There was a trend of decreasing oral moxifloxacin usage comparing XX to XX; however, it might be an artifact of seasonal change. Comparing XX to XX, the total number of patients on oral moxifloxacin did not change significantly.
  • The antibiotic stewardship program will continue to monitor oral azithromycin usage via pharmacist/house staff education on duration of therapy and prevent double atypical coverage for asthma, chronic obstructive pulmonary disease, or community-acquired pneumonia.
Current as of September 2012
Internet Citation: Ø 4D TOOL: Medication Use Evaluation Template. September 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/cdifftoolkit/cdiffl2tools4d.html