Review/Audit of Antibiotic Use, Orders and Policies/Protocols Audit Tool and Reporting The tool contains 12 identical sheets (for 12 months/year); enter the month and year for the applicable audit.

Facilities and the antibiotic stewardship team should determine and select measures based upon their Quality Assurance and Performance Improvement (QAPI) program. Your Team may select all measures or only a select few. The audit tool can be used prospective/concurrently or retrospectively. The number of records (residents) to be reviewed and the periodicity should be determined by the QAPI process. The tool will automatically provide statistics and graphs as audit data is entered. Use caution with copying or editing the sheets as they may contain calculation formulas. References:

Clinical Audit Antibiotic Prescribing. CQC Outcome 9: Management of medicines. CopyrightCPDrecords.com 2011. http://www.cpdrecords.com/uploads/files/audit-Algorithms Promoting Antimicrobial Stewardship in Long-Term Care. JAMDA 17 (2016) 173-178. http://www.jamda.com/article/S1525-8610(15)00728-8/abstract Start Smart Then Focus Appendix 1 Resource Materials: Examples of audit tools, review stickers and drug charts. Start Smart - Then Focus Antimicrobial Stewardship Toolkit for English Hospitals Updated March 2015. Antimicrobial Use and Resistance (AUR) Module. January 2016. http://www.cdc.gov/nhsn/PDFs/pscManual/11pscAURcurrent.pdf Loeb Criteria: Skin/Soft Tissue, UTI, LRTI - Resident Assessment Forms - Nancy Losben

Jennifer Thomas, PharmD October 2016

This material was prepared by the Atlantic Quality Innovation Network (AQIN), the Medicare Quality Innovation NetworkQuality Improvement Organization for New York State, South Carolina, and the District of Columbia, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy. 11SOW

1

https://www.cdc.gov/nhsn/PDFs/pscManual/11pscAURcurrent.pdfhttp://www.jamda.com/article/S1525-8610(15)00728-8/abstracthttp://www.cpdrecords.com/workplace-cpd-activity-detail.php?id=18

Antimicrobial Stewardship Quality & Performance Measures

Measurement Process Measures

1. Commitment to and Leadership for Antimicrobial Stewardship A) Does the facility have a policy regarding antimicrobial stewardship? Yes/No B) Does the facility have designated resources for antimicrobial stewardship? To include infection preventionist, pharmacist, infectious diseases consultant, microbiology consultant or laboratory consultant

C) Does the facility have evidence based infectious disease treatment guidelines for the most common infections (CAP, UTI, SSTI, confirmed blood stream infections,C. difficile infections?

2. Appropriate Prescribing/Adherence of antimicrobial orders: A) Appropriate C&S obtained for antimicrobial use and/or prior C&S documented? Yes/No B) Appropriate drug dosing, such as optimization of PK/PD and dosing for organ function? Yes/No C) Indication for Use provided for each order? Y/N D) Duration of therapy provided with each order (Start and Stop date indicated or specific number of days included in the original and subsequent orders? Yes/No

E) Appropriate drug for indication and/or facility treatment guidelines Yes/No: CAP URTI Yes/No, UTI Yes/No, SSTI Yes/No, Blood Steam infection Yes/No, C. difficile Yes/No,

F) Review and approval (prior authorization) for restricted or high risk/high cost antimicrobials? Yes/No G) Review of Appropriateness of order within 7296 hours? Yes/No (includes review of automatic stop orders, empiric therapy per antibiogram and disease specific empiric guidelines, C&S obtained and reviewed for definitive therapy, restricted or high risk/high cost regimens) H) Review for unnecessary duplicative therapy? Yes/No

Outcome Measures: 3. Monitor Antimicrobial Use and Outcomes

A) Antimicrobial Consumption by one of the following: by month or quarter i) Counts of antimicrobials administered to residents per day (Days of Therapy; DOT) ii) Number of grams of antimicrobials used (Defined Daily Dose; DDD) iii) Direct expenditure for antibiotics (purchasing costs) B) Antimicrobial Use orders for residents, by prescriber: number of residents with antimicrobial orders per month (quarter), by physician C) Antimicrobial treatment Success (improvement in clinical signs/symptoms) or Failure (lack of improvement in clinical signs/symptoms requiring change in therapy, hospitalization and/or death)

4. Monitor Antimicrobial Adverse Events A) Track C. difficile infection B) Report Adverse Drug Events by: class of agent, event, event type, severity (NCC MERP). Report total number of events per 1000 residents each quarter

REPORTING INFORMATION TO STAFF ON IMPROVING ANTIBIOTIC USE AND RESISTANCE 1. Report facility specific antimicrobial measures summary to the medical staff, quality department, Administrator, Director of Nursing and frontline staff: antimicrobial use consumption, number of residents on antimicrobials per month (quarter), and by prescriber, appropriate use/adherence process measures, and outcome measure 2. Provide an antibiogram annually and report on changes in resistance patterns with medical staff, quality and facility staff. 3. Provide education to clinicians and relevant staff on improving antimicrobial prescribing, monitoring and outcomes. 4. Incorporate measurement, education, and training into the facilitys QAPI program.

References: Checklist for Core Elements Hospital Antimicrobial Stewardship Program. CDC National Center for Emerging and Zoonotic Infectious Diseases and Division of Healthcare Quality Promotion. http://www.cdc.gov/getsmart/healthcare/pdfs/checklist.pdf Accessed March 11, 2016 Nursing Home Antimicrobial Stewardship Modules http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/nh-aspguide/index.html Accessed March 11, 2016 Start Smart Then Focus Appendix 1 Resource Materials: Examples of audit tools, review stickers, and drug chart. Public Health England 2015. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/417041/Revised_SSTF_Tools_Annex_FINAL.pdf Accessed March 11, 2016 Strategies for Improving Antimicrobial Use and the Role of Antimicrobial Stewardship Programs http://cid.oxfordjournals.org/content/53/suppl_1/S15.full

CDC Get Smart for Healthcare. CDC/IHI Antibiotic Stewardship Drivers and Change Package. Antibiotic Stewardship Measurement Framework http://www.cdc.gov/getsmart/healthcare/pdfs/antibiotic_stewardship_measurement_framework.pdf

Vital Signs Technical Appendix: Estimating the potential reductions in Clostridium difficile infection (CDI) among patients when antibiotic use is improved http://www.cdc.gov/getsmart/healthcare/evidence/cdiff.html#_ENREF_6

The Joint Commission (TJC) Proposed Standard for Antimicrobial Stewardship in AHC, CAH, HAP, NCC, and OBS (Hospital, Ambulatory Health Care, Critical Access Hospitals, Nursing Care Centers, Office Based Surgery. Proposed Standard MM.01.01.09 (Medical Management). https://jointcommission.az1.qualtrics.com/CP/File.php?F=F_5tDHGzIVDMHenDn

2

https://jointcommission.az1.qualtrics.com/CP/File.php?F=F_5tDHGzIVDMHenDnhttps://www.cdc.gov/antibiotic-use/healthcare/evidence/asp-int-cdiff.htmlhttps://www.cdc.gov/antibiotic-use/healthcare/pdfs/Antibiotic_Stewardship_Change_Package.pdfhttps://academic.oup.com/cid/article/53/suppl_1/S15/426818https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/417041/Revised_SSTF_Tools_Annex_FINAL.pdfhttps://www.ahrq.gov/nhguide/index.htmlhttps://www.cdc.gov/getsmart/healthcare/pdfs/core-elements.pdf

Appendix. Example Audit Tools Reference. Start Smart Then Focus Appendix 1 Resource Materials: Examples of audit tools, review stickers, and drug chart

EXAMPLES OF SIMILAR AUDIT TOOLS COMPLETED

3

Review/Audit of Antibiotic Use, Orders and Policies/Protocols Year: AUDIT RECORDING FORM

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Total Records Reviewed

Total Criteria Met

%

Recorded Information

Was Antibiotic Use Appropriate? Total Records

Total Criteria %

Do you have an Antibiotic Protocol or Treatment Guidelines which you followed? Was a clinical diagnosis of the problem recorded? Did the antibiotic order include appropriate dose? Did the antibiotic order include the appropriate frequency?

Was the duration of antibotic included in the order?

Was appropriate monitoring (drug levels - if no TDM is necessary leave this blank) Was appropriate antibiotic organ system monitoring obtained? (renal, hepatic)

Was a C&S obtained OR if prior C&S, diagnosis is documented in the record (osteomyelitis, central line infection, etc.)? Was the organism sensitive to the prescribed antibiotic? Was the antibiotic changed to directed therapy once C&S results were available = within 72-96 hours)?

Was there unnecessary duplicate antibiotic therapy?

Were criteria for restricted antibiotic use met, i.e prior approval /authorization?

Month: Review 10 to 20 patients residents who have recently had antibiotics ordered/prescribed. Facility AbStewardship Team Determine and Select the Measures to be Audited. The facility may select all or only a few of the measures. Each number, 1- 20 represents a resident reviewed. Enter Yes or No for each measure your team selects for review (rows 7 - 92). Under the number, you may desire to enter the resident initial or identifier for later reference.

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met

%

4

Where any of the following clinical features present?

Total Records Reviewed

Total Criteria Met

%

Skin/Soft tissue Infection (Loeb)

New or increasing purulent drainage at a wound, skin, or soft-tissue site OR at least 2 of the following

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature) Redness

Tenderness

Warmth

New or increasing swelling

UTI

Acute dysuria

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature) New or worsening: Urinary incontinence and/or

Urgency and/or

Frequency and/or

Suprapubic pain and/or

Gross hematuria and/or

Costovertebral angle tenderness

UTI with indwelling catheter (catheter associated UTI) (Loeb Criteria) at least one of the following Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature New costovertebral tenderness

Rigors

New onset delirium

Pneumonia

Fever > 102 F and at least one of the following: Fever 2.4F increase above baseline temperature, and cough and at least one of the following: AND at least one of the following

New or increased cough

Pulse >100;

Rigors

Delirium

Respiratory rate >25 OR

Afebrile resident with COPD and >65 years and new or increased cough with purulent sputum production OR

Afebrile resident without COPD and new cough with purulent sputum production and at least one of the following:

AND at least one of the following

Respiratory rate >25 OR

Delirium

In patients with spinal cord injury, fever, pain over

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met

%

0

0.2

0.4

0.6

0.8

1

1.2

Series1

Series2

Series3

kidney or bladder during urination, onset of urinary incontinence, increased spascity, autonomic dysreflexia or sense of unease may be comparable with CAUTI

0

0.2

0.4

0.6

0.8

1

1.2

UTI with indwelling catheter (catheter associated UTI) (Loeb Criteria) at least one of the following

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature New costovertebral tendernessRigorsNew onset delirium

Series1

Series2

Series3

0

0.2

0.4

0.6

0.8

1

1.2

Pneu

mon

iaFever >

102

F and

at

New

or increased

Pu

lse >1

00;

Rigors

Delirium

Respira

tory

rate

>25

Afeb

rile reside

nt with

Afeb

rile reside

nt

Respira

tory

rate

>25

Delirium

Prod

uctiv

e cough

Chest Xray

and

Co

ugh

pulse >100

worsening

men

tal

rigors

Series1

Series2

Series3

5

New Fever 2.4F increase above infiltrate on chest X-ray thought to represent pneumonia baseline temperature Productive cough

Chest X-ray and complete cell count with differential is reasonable for residents with fever

Cough

AND at least one of the following

pulse >100

worsening mental status

rigors

Total Records Reviewed

Total Criteria Met

%

a) Antibiotic #1

Enter # Days of Therapy (DOT) (a)

b) Antibiotic #2

Enter # Days of Therapy (DOT) (b)

c) Antibiotic #3

Enter # Days of Therapy (DOT) (c )

d) Antibiotic #4

Enter # Days of Therapy (DOT) (d)

e. Antibiotic #5

Enter #Days of Therapy (DOT) (e)

Days of Therapy Total Total % Total Days of Therapy (DOT) (a-e)

Antibiotic Consumption: Which antibiotic was ordered? [The user should edit the specific antibiotic(s) within the class below used in their facility. i.e. Fluoroquinolones - enter levofloxacin, if more than one fluoroquinolone copy the row and add to the tool.] and Days of Therapy.

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met %

Total Days of Therapy (DOT) (ae)

Total Days of Therapy (DOT) (ae)

6

Outcome of Therapy Total Records Reviewed

Total Criteria Met

%

Clinical Improvement? T < 38C, systolic BP >90 mmHg, RR

Review/Audit of Antibiotic Use, Orders and Policies/Protocols Year: AUDIT RECORDING FORM

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Total Records Reviewed

Total Criteria Met

%

Recorded Information

Was Antibiotic Use Appropriate? Total Records

Total Criteria %

Do you have an Antibiotic Protocol or Treatment Guidelines which you followed? Was a clinical diagnosis of the problem recorded? Did the antibiotic order include appropriate dose? Did the antibiotic order include the appropriate frequency?

Was the duration of antibotic included in the order?

Was appropriate monitoring (drug levels - if no TDM is necessary leave this blank) Was appropriate antibiotic organ system monitoring obtained? (renal, hepatic)

Was a C&S obtained OR if prior C&S, diagnosis is documented in the record (osteomyelitis, central line infection, etc.)? Was the organism sensitive to the prescribed antibiotic? Was the antibiotic changed to directed therapy once C&S results were available = within 72-96 hours)?

Was there unnecessary duplicate antibiotic therapy?

Were criteria for restricted antibiotic use met, i.e prior approval /authorization?

Month: Review 10 to 20 patients residents who have recently had antibiotics ordered/prescribed. Facility AbStewardship Team Determine and Select the Measures to be Audited. The facility may select all or only a few of the measures. Each number, 1- 20 represents a resident reviewed. Enter Yes or No for each measure your team selects for review (rows 7 - 92). Under the number, you may desire to enter the resident initial or identifier for later reference.

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met

%

8

Where any of the following clinical features present?

Total Records Reviewed

Total Criteria Met

%

Skin/Soft tissue Infection (Loeb)

New or increasing purulent drainage at a wound, skin, or soft-tissue site OR at least 2 of the following

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature) Redness

Tenderness

Warmth

New or increasing swelling

UTI

Acute dysuria

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature) New or worsening: Urinary incontinence and/or

Urgency and/or

Frequency and/or

Suprapubic pain and/or

Gross hematuria and/or

Costovertebral angle tenderness

UTI with indwelling catheter (catheter associated UTI) (Loeb Criteria) at least one of the following Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature New costovertebral tenderness

Rigors

New onset delirium

Pneumonia

Fever > 102 F and at least one of the following: Fever 2.4F increase above baseline temperature, and cough and at least one of the following: AND at least one of the following

New or increased cough

Pulse >100;

Rigors

Delirium

Respiratory rate >25 OR

Afebrile resident with COPD and >65 years and new or increased cough with purulent sputum production OR

Afebrile resident without COPD and new cough with purulent sputum production and at least one of the following:

AND at least one of the following

Respiratory rate >25 OR

Delirium

In patients with spinal cord injury, fever, pain over

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met

%

0

0.2

0.4

0.6

0.8

1

1.2

Series1

Series2

Series3

kidney or bladder during urination, onset of urinary incontinence, increased spascity, autonomic dysreflexia or sense of unease may be comparable with CAUTI

0

0.2

0.4

0.6

0.8

1

1.2

UTI with indwelling catheter (catheter associated UTI) (Loeb Criteria) at least one of the following

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature New costovertebral tendernessRigorsNew onset delirium

Series1

Series2

Series3

0

0.2

0.4

0.6

0.8

1

1.2

Pneu

mon

iaFever >

102

F and

at

New

or increased

Pu

lse >1

00;

Rigors

Delirium

Respira

tory

rate

>25

Afeb

rile reside

nt with

Afeb

rile reside

nt

Respira

tory

rate

>25

Delirium

Prod

uctiv

e cough

Chest Xray

and

Co

ugh

pulse >100

worsening

men

tal

rigors

Series1

Series2

Series3

9

New Fever 2.4F increase above infiltrate on chest X-ray thought to represent pneumonia baseline temperature Productive cough

Chest X-ray and complete cell count with differential is reasonable for residents with fever

Cough

AND at least one of the following

pulse >100

worsening mental status

rigors

Total Records Reviewed

Total Criteria Met

%

a) Antibiotic #1

Enter # Days of Therapy (DOT) (a)

b) Antibiotic #2

Enter # Days of Therapy (DOT) (b)

c) Antibiotic #3

Enter # Days of Therapy (DOT) (c )

d) Antibiotic #4

Enter # Days of Therapy (DOT) (d)

e. Antibiotic #5

Enter #Days of Therapy (DOT) (e)

Days of Therapy Total Total % Total Days of Therapy (DOT) (a-e)

Antibiotic Consumption: Which antibiotic was ordered? [The user should edit the specific antibiotic(s) within the class below used in their facility. i.e. Fluoroquinolones - enter levofloxacin, if more than one fluoroquinolone copy the row and add to the tool.] and Days of Therapy.

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met %

Total Days of Therapy (DOT) (ae)

Total Days of Therapy (DOT) (ae)

10

Outcome of Therapy Total Records Reviewed

Total Criteria Met

%

Clinical Improvement? T < 38C, systolic BP >90 mmHg, RR

Review/Audit of Antibiotic Use, Orders and Policies/Protocols Year: AUDIT RECORDING FORM

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Total Records Reviewed

Total Criteria Met

%

Recorded Information

Was Antibiotic Use Appropriate? Total Records

Total Criteria %

Do you have an Antibiotic Protocol or Treatment Guidelines which you followed? Was a clinical diagnosis of the problem recorded? Did the antibiotic order include appropriate dose? Did the antibiotic order include the appropriate frequency?

Was the duration of antibotic included in the order?

Was appropriate monitoring (drug levels - if no TDM is necessary leave this blank) Was appropriate antibiotic organ system monitoring obtained? (renal, hepatic)

Was a C&S obtained OR if prior C&S, diagnosis is documented in the record (osteomyelitis, central line infection, etc.)? Was the organism sensitive to the prescribed antibiotic? Was the antibiotic changed to directed therapy once C&S results were available = within 72-96 hours)?

Was there unnecessary duplicate antibiotic therapy?

Were criteria for restricted antibiotic use met, i.e prior approval /authorization?

Month: Review 10 to 20 patients residents who have recently had antibiotics ordered/prescribed. Facility AbStewardship Team Determine and Select the Measures to be Audited. The facility may select all or only a few of the measures. Each number, 1- 20 represents a resident reviewed. Enter Yes or No for each measure your team selects for review (rows 7 - 92). Under the number, you may desire to enter the resident initial or identifier for later reference.

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met

%

12

Where any of the following clinical features present?

Total Records Reviewed

Total Criteria Met

%

Skin/Soft tissue Infection (Loeb)

New or increasing purulent drainage at a wound, skin, or soft-tissue site OR at least 2 of the following

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature) Redness

Tenderness

Warmth

New or increasing swelling

UTI

Acute dysuria

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature) New or worsening: Urinary incontinence and/or

Urgency and/or

Frequency and/or

Suprapubic pain and/or

Gross hematuria and/or

Costovertebral angle tenderness

UTI with indwelling catheter (catheter associated UTI) (Loeb Criteria) at least one of the following Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature New costovertebral tenderness

Rigors

New onset delirium

Pneumonia

Fever > 102 F and at least one of the following: Fever 2.4F increase above baseline temperature, and cough and at least one of the following: AND at least one of the following

New or increased cough

Pulse >100;

Rigors

Delirium

Respiratory rate >25 OR

Afebrile resident with COPD and >65 years and new or increased cough with purulent sputum production OR

Afebrile resident without COPD and new cough with purulent sputum production and at least one of the following:

AND at least one of the following

Respiratory rate >25 OR

Delirium

In patients with spinal cord injury, fever, pain over

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met

%

0

0.2

0.4

0.6

0.8

1

1.2

Series1

Series2

Series3

kidney or bladder during urination, onset of urinary incontinence, increased spascity, autonomic dysreflexia or sense of unease may be comparable with CAUTI

0

0.2

0.4

0.6

0.8

1

1.2

UTI with indwelling catheter (catheter associated UTI) (Loeb Criteria) at least one of the following

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature New costovertebral tendernessRigorsNew onset delirium

Series1

Series2

Series3

0

0.2

0.4

0.6

0.8

1

1.2

Pneu

mon

iaFever >

102

F and

at

New

or increased

Pu

lse >1

00;

Rigors

Delirium

Respira

tory

rate

>25

Afeb

rile reside

nt with

Afeb

rile reside

nt

Respira

tory

rate

>25

Delirium

Prod

uctiv

e cough

Chest Xray

and

Co

ugh

pulse >100

worsening

men

tal

rigors

Series1

Series2

Series3

13

New Fever 2.4F increase above infiltrate on chest X-ray thought to represent pneumonia baseline temperature Productive cough

Chest X-ray and complete cell count with differential is reasonable for residents with fever

Cough

AND at least one of the following

pulse >100

worsening mental status

rigors

Total Records Reviewed

Total Criteria Met

%

a) Antibiotic #1

Enter # Days of Therapy (DOT) (a)

b) Antibiotic #2

Enter # Days of Therapy (DOT) (b)

c) Antibiotic #3

Enter # Days of Therapy (DOT) (c )

d) Antibiotic #4

Enter # Days of Therapy (DOT) (d)

e. Antibiotic #5

Enter #Days of Therapy (DOT) (e)

Days of Therapy Total Total % Total Days of Therapy (DOT) (a-e)

Antibiotic Consumption: Which antibiotic was ordered? [The user should edit the specific antibiotic(s) within the class below used in their facility. i.e. Fluoroquinolones - enter levofloxacin, if more than one fluoroquinolone copy the row and add to the tool.] and Days of Therapy.

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met %

Total Days of Therapy (DOT) (ae)

Total Days of Therapy (DOT) (ae)

14

Outcome of Therapy Total Records Reviewed

Total Criteria Met

%

Clinical Improvement? T < 38C, systolic BP >90 mmHg, RR

Review/Audit of Antibiotic Use, Orders and Policies/Protocols Year: AUDIT RECORDING FORM

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Total Records Reviewed

Total Criteria Met

%

Recorded Information

Was Antibiotic Use Appropriate? Total Records

Total Criteria %

Do you have an Antibiotic Protocol or Treatment Guidelines which you followed? Was a clinical diagnosis of the problem recorded? Did the antibiotic order include appropriate dose? Did the antibiotic order include the appropriate frequency?

Was the duration of antibotic included in the order?

Was appropriate monitoring (drug levels - if no TDM is necessary leave this blank) Was appropriate antibiotic organ system monitoring obtained? (renal, hepatic)

Was a C&S obtained OR if prior C&S, diagnosis is documented in the record (osteomyelitis, central line infection, etc.)? Was the organism sensitive to the prescribed antibiotic? Was the antibiotic changed to directed therapy once C&S results were available = within 72-96 hours)?

Was there unnecessary duplicate antibiotic therapy?

Were criteria for restricted antibiotic use met, i.e prior approval /authorization?

Month: Review 10 to 20 patients residents who have recently had antibiotics ordered/prescribed. Facility AbStewardship Team Determine and Select the Measures to be Audited. The facility may select all or only a few of the measures. Each number, 1- 20 represents a resident reviewed. Enter Yes or No for each measure your team selects for review (rows 7 - 92). Under the number, you may desire to enter the resident initial or identifier for later reference.

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met

%

16

Where any of the following clinical features present?

Total Records Reviewed

Total Criteria Met

%

Skin/Soft tissue Infection (Loeb)

New or increasing purulent drainage at a wound, skin, or soft-tissue site OR at least 2 of the following

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature) Redness

Tenderness

Warmth

New or increasing swelling

UTI

Acute dysuria

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature) New or worsening: Urinary incontinence and/or

Urgency and/or

Frequency and/or

Suprapubic pain and/or

Gross hematuria and/or

Costovertebral angle tenderness

UTI with indwelling catheter (catheter associated UTI) (Loeb Criteria) at least one of the following Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature New costovertebral tenderness

Rigors

New onset delirium

Pneumonia

Fever > 102 F and at least one of the following: Fever 2.4F increase above baseline temperature, and cough and at least one of the following: AND at least one of the following

New or increased cough

Pulse >100;

Rigors

Delirium

Respiratory rate >25 OR

Afebrile resident with COPD and >65 years and new or increased cough with purulent sputum production OR

Afebrile resident without COPD and new cough with purulent sputum production and at least one of the following:

AND at least one of the following

Respiratory rate >25 OR

Delirium

In patients with spinal cord injury, fever, pain over

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met

%

0

0.2

0.4

0.6

0.8

1

1.2

Series1

Series2

Series3

kidney or bladder during urination, onset of urinary incontinence, increased spascity, autonomic dysreflexia or sense of unease may be comparable with CAUTI

0

0.2

0.4

0.6

0.8

1

1.2

UTI with indwelling catheter (catheter associated UTI) (Loeb Criteria) at least one of the following

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature New costovertebral tendernessRigorsNew onset delirium

Series1

Series2

Series3

0

0.2

0.4

0.6

0.8

1

1.2

Pneu

mon

iaFever >

102

F and

at

New

or increased

Pu

lse >1

00;

Rigors

Delirium

Respira

tory

rate

>25

Afeb

rile reside

nt with

Afeb

rile reside

nt

Respira

tory

rate

>25

Delirium

Prod

uctiv

e cough

Chest Xray

and

Co

ugh

pulse >100

worsening

men

tal

rigors

Series1

Series2

Series3

17

New Fever 2.4F increase above infiltrate on chest X-ray thought to represent pneumonia baseline temperature Productive cough

Chest X-ray and complete cell count with differential is reasonable for residents with fever

Cough

AND at least one of the following

pulse >100

worsening mental status

rigors

Total Records Reviewed

Total Criteria Met

%

a) Antibiotic #1

Enter # Days of Therapy (DOT) (a)

b) Antibiotic #2

Enter # Days of Therapy (DOT) (b)

c) Antibiotic #3

Enter # Days of Therapy (DOT) (c )

d) Antibiotic #4

Enter # Days of Therapy (DOT) (d)

e. Antibiotic #5

Enter #Days of Therapy (DOT) (e)

Days of Therapy Total Total % Total Days of Therapy (DOT) (a-e)

Antibiotic Consumption: Which antibiotic was ordered? [The user should edit the specific antibiotic(s) within the class below used in their facility. i.e. Fluoroquinolones - enter levofloxacin, if more than one fluoroquinolone copy the row and add to the tool.] and Days of Therapy.

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met %

Total Days of Therapy (DOT) (ae)

Total Days of Therapy (DOT) (ae)

18

Outcome of Therapy Total Records Reviewed

Total Criteria Met

%

Clinical Improvement? T < 38C, systolic BP >90 mmHg, RR

Review/Audit of Antibiotic Use, Orders and Policies/Protocols Year: AUDIT RECORDING FORM

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Total Records Reviewed

Total Criteria Met

%

Recorded Information

Was Antibiotic Use Appropriate? Total Records

Total Criteria %

Do you have an Antibiotic Protocol or Treatment Guidelines which you followed? Was a clinical diagnosis of the problem recorded? Did the antibiotic order include appropriate dose? Did the antibiotic order include the appropriate frequency?

Was the duration of antibotic included in the order?

Was appropriate monitoring (drug levels - if no TDM is necessary leave this blank) Was appropriate antibiotic organ system monitoring obtained? (renal, hepatic)

Was a C&S obtained OR if prior C&S, diagnosis is documented in the record (osteomyelitis, central line infection, etc.)? Was the organism sensitive to the prescribed antibiotic? Was the antibiotic changed to directed therapy once C&S results were available = within 72-96 hours)?

Was there unnecessary duplicate antibiotic therapy?

Were criteria for restricted antibiotic use met, i.e prior approval /authorization?

Month: Review 10 to 20 patients residents who have recently had antibiotics ordered/prescribed. Facility AbStewardship Team Determine and Select the Measures to be Audited. The facility may select all or only a few of the measures. Each number, 1- 20 represents a resident reviewed. Enter Yes or No for each measure your team selects for review (rows 7 - 92). Under the number, you may desire to enter the resident initial or identifier for later reference.

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met

%

20

Where any of the following clinical features present?

Total Records Reviewed

Total Criteria Met

%

Skin/Soft tissue Infection (Loeb)

New or increasing purulent drainage at a wound, skin, or soft-tissue site OR at least 2 of the following

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature) Redness

Tenderness

Warmth

New or increasing swelling

UTI

Acute dysuria

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature) New or worsening: Urinary incontinence and/or

Urgency and/or

Frequency and/or

Suprapubic pain and/or

Gross hematuria and/or

Costovertebral angle tenderness

UTI with indwelling catheter (catheter associated UTI) (Loeb Criteria) at least one of the following Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature New costovertebral tenderness

Rigors

New onset delirium

Pneumonia

Fever > 102 F and at least one of the following: Fever 2.4F increase above baseline temperature, and cough and at least one of the following: AND at least one of the following

New or increased cough

Pulse >100;

Rigors

Delirium

Respiratory rate >25 OR

Afebrile resident with COPD and >65 years and new or increased cough with purulent sputum production OR

Afebrile resident without COPD and new cough with purulent sputum production and at least one of the following:

AND at least one of the following

Respiratory rate >25 OR

Delirium

In patients with spinal cord injury, fever, pain over

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met

%

0

0.2

0.4

0.6

0.8

1

1.2

Series1

Series2

Series3

kidney or bladder during urination, onset of urinary incontinence, increased spascity, autonomic dysreflexia or sense of unease may be comparable with CAUTI

0

0.2

0.4

0.6

0.8

1

1.2

UTI with indwelling catheter (catheter associated UTI) (Loeb Criteria) at least one of the following

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature New costovertebral tendernessRigorsNew onset delirium

Series1

Series2

Series3

0

0.2

0.4

0.6

0.8

1

1.2

Pneu

mon

iaFever >

102

F and

at

New

or increased

Pu

lse >1

00;

Rigors

Delirium

Respira

tory

rate

>25

Afeb

rile reside

nt with

Afeb

rile reside

nt

Respira

tory

rate

>25

Delirium

Prod

uctiv

e cough

Chest Xray

and

Co

ugh

pulse >100

worsening

men

tal

rigors

Series1

Series2

Series3

21

New Fever 2.4F increase above infiltrate on chest X-ray thought to represent pneumonia baseline temperature Productive cough

Chest X-ray and complete cell count with differential is reasonable for residents with fever

Cough

AND at least one of the following

pulse >100

worsening mental status

rigors

Total Records Reviewed

Total Criteria Met

%

a) Antibiotic #1

Enter # Days of Therapy (DOT) (a)

b) Antibiotic #2

Enter # Days of Therapy (DOT) (b)

c) Antibiotic #3

Enter # Days of Therapy (DOT) (c )

d) Antibiotic #4

Enter # Days of Therapy (DOT) (d)

e. Antibiotic #5

Enter #Days of Therapy (DOT) (e)

Days of Therapy Total Total % Total Days of Therapy (DOT) (a-e)

Antibiotic Consumption: Which antibiotic was ordered? [The user should edit the specific antibiotic(s) within the class below used in their facility. i.e. Fluoroquinolones - enter levofloxacin, if more than one fluoroquinolone copy the row and add to the tool.] and Days of Therapy.

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met %

Total Days of Therapy (DOT) (ae)

Total Days of Therapy (DOT) (ae)

22

Outcome of Therapy Total Records Reviewed

Total Criteria Met

%

Clinical Improvement? T < 38C, systolic BP >90 mmHg, RR

Review/Audit of Antibiotic Use, Orders and Policies/Protocols Year: AUDIT RECORDING FORM

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Total Records Reviewed

Total Criteria Met

%

Recorded Information

Was Antibiotic Use Appropriate? Total Records

Total Criteria %

Do you have an Antibiotic Protocol or Treatment Guidelines which you followed? Was a clinical diagnosis of the problem recorded? Did the antibiotic order include appropriate dose? Did the antibiotic order include the appropriate frequency?

Was the duration of antibotic included in the order?

Was appropriate monitoring (drug levels - if no TDM is necessary leave this blank) Was appropriate antibiotic organ system monitoring obtained? (renal, hepatic)

Was a C&S obtained OR if prior C&S, diagnosis is documented in the record (osteomyelitis, central line infection, etc.)? Was the organism sensitive to the prescribed antibiotic? Was the antibiotic changed to directed therapy once C&S results were available = within 72-96 hours)?

Was there unnecessary duplicate antibiotic therapy?

Were criteria for restricted antibiotic use met, i.e prior approval /authorization?

Month: Review 10 to 20 patients residents who have recently had antibiotics ordered/prescribed. Facility AbStewardship Team Determine and Select the Measures to be Audited. The facility may select all or only a few of the measures. Each number, 1- 20 represents a resident reviewed. Enter Yes or No for each measure your team selects for review (rows 7 - 92). Under the number, you may desire to enter the resident initial or identifier for later reference.

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met

%

24

Where any of the following clinical features present?

Total Records Reviewed

Total Criteria Met

%

Skin/Soft tissue Infection (Loeb)

New or increasing purulent drainage at a wound, skin, or soft-tissue site OR at least 2 of the following

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature) Redness

Tenderness

Warmth

New or increasing swelling

UTI

Acute dysuria

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature) New or worsening: Urinary incontinence and/or

Urgency and/or

Frequency and/or

Suprapubic pain and/or

Gross hematuria and/or

Costovertebral angle tenderness

UTI with indwelling catheter (catheter associated UTI) (Loeb Criteria) at least one of the following Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature New costovertebral tenderness

Rigors

New onset delirium

Pneumonia

Fever > 102 F and at least one of the following: Fever 2.4F increase above baseline temperature, and cough and at least one of the following: AND at least one of the following

New or increased cough

Pulse >100;

Rigors

Delirium

Respiratory rate >25 OR

Afebrile resident with COPD and >65 years and new or increased cough with purulent sputum production OR

Afebrile resident without COPD and new cough with purulent sputum production and at least one of the following:

AND at least one of the following

Respiratory rate >25 OR

Delirium

In patients with spinal cord injury, fever, pain over

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met

%

0

0.2

0.4

0.6

0.8

1

1.2

Series1

Series2

Series3

kidney or bladder during urination, onset of urinary incontinence, increased spascity, autonomic dysreflexia or sense of unease may be comparable with CAUTI

0

0.2

0.4

0.6

0.8

1

1.2

UTI with indwelling catheter (catheter associated UTI) (Loeb Criteria) at least one of the following

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature New costovertebral tendernessRigorsNew onset delirium

Series1

Series2

Series3

0

0.2

0.4

0.6

0.8

1

1.2

Pneu

mon

iaFever >

102

F and

at

New

or increased

Pu

lse >1

00;

Rigors

Delirium

Respira

tory

rate

>25

Afeb

rile reside

nt with

Afeb

rile reside

nt

Respira

tory

rate

>25

Delirium

Prod

uctiv

e cough

Chest Xray

and

Co

ugh

pulse >100

worsening

men

tal

rigors

Series1

Series2

Series3

25

New Fever 2.4F increase above infiltrate on chest X-ray thought to represent pneumonia baseline temperature Productive cough

Chest X-ray and complete cell count with differential is reasonable for residents with fever

Cough

AND at least one of the following

pulse >100

worsening mental status

rigors

Total Records Reviewed

Total Criteria Met

%

a) Antibiotic #1

Enter # Days of Therapy (DOT) (a)

b) Antibiotic #2

Enter # Days of Therapy (DOT) (b)

c) Antibiotic #3

Enter # Days of Therapy (DOT) (c )

d) Antibiotic #4

Enter # Days of Therapy (DOT) (d)

e. Antibiotic #5

Enter #Days of Therapy (DOT) (e)

Days of Therapy Total Total % Total Days of Therapy (DOT) (a-e)

Antibiotic Consumption: Which antibiotic was ordered? [The user should edit the specific antibiotic(s) within the class below used in their facility. i.e. Fluoroquinolones - enter levofloxacin, if more than one fluoroquinolone copy the row and add to the tool.] and Days of Therapy.

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met %

Total Days of Therapy (DOT) (ae)

Total Days of Therapy (DOT) (ae)

26

Outcome of Therapy Total Records Reviewed

Total Criteria Met

%

Clinical Improvement? T < 38C, systolic BP >90 mmHg, RR

Review/Audit of Antibiotic Use, Orders and Policies/Protocols Year: AUDIT RECORDING FORM

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Total Records Reviewed

Total Criteria Met

%

Recorded Information

Was Antibiotic Use Appropriate? Total Records

Total Criteria %

Do you have an Antibiotic Protocol or Treatment Guidelines which you followed? Was a clinical diagnosis of the problem recorded? Did the antibiotic order include appropriate dose? Did the antibiotic order include the appropriate frequency?

Was the duration of antibotic included in the order?

Was appropriate monitoring (drug levels - if no TDM is necessary leave this blank) Was appropriate antibiotic organ system monitoring obtained? (renal, hepatic)

Was a C&S obtained OR if prior C&S, diagnosis is documented in the record (osteomyelitis, central line infection, etc.)? Was the organism sensitive to the prescribed antibiotic? Was the antibiotic changed to directed therapy once C&S results were available = within 72-96 hours)?

Was there unnecessary duplicate antibiotic therapy?

Were criteria for restricted antibiotic use met, i.e prior approval /authorization?

Month: Review 10 to 20 patients residents who have recently had antibiotics ordered/prescribed. Facility AbStewardship Team Determine and Select the Measures to be Audited. The facility may select all or only a few of the measures. Each number, 1- 20 represents a resident reviewed. Enter Yes or No for each measure your team selects for review (rows 7 - 92). Under the number, you may desire to enter the resident initial or identifier for later reference.

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met

%

28

Where any of the following clinical features present?

Total Records Reviewed

Total Criteria Met

%

Skin/Soft tissue Infection (Loeb)

New or increasing purulent drainage at a wound, skin, or soft-tissue site OR at least 2 of the following

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature) Redness

Tenderness

Warmth

New or increasing swelling

UTI

Acute dysuria

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature) New or worsening: Urinary incontinence and/or

Urgency and/or

Frequency and/or

Suprapubic pain and/or

Gross hematuria and/or

Costovertebral angle tenderness

UTI with indwelling catheter (catheter associated UTI) (Loeb Criteria) at least one of the following Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature New costovertebral tenderness

Rigors

New onset delirium

Pneumonia

Fever > 102 F and at least one of the following: Fever 2.4F increase above baseline temperature, and cough and at least one of the following: AND at least one of the following

New or increased cough

Pulse >100;

Rigors

Delirium

Respiratory rate >25 OR

Afebrile resident with COPD and >65 years and new or increased cough with purulent sputum production OR

Afebrile resident without COPD and new cough with purulent sputum production and at least one of the following:

AND at least one of the following

Respiratory rate >25 OR

Delirium

In patients with spinal cord injury, fever, pain over

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met

%

0

0.2

0.4

0.6

0.8

1

1.2

Series1

Series2

Series3

kidney or bladder during urination, onset of urinary incontinence, increased spascity, autonomic dysreflexia or sense of unease may be comparable with CAUTI

0

0.2

0.4

0.6

0.8

1

1.2

UTI with indwelling catheter (catheter associated UTI) (Loeb Criteria) at least one of the following

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature New costovertebral tendernessRigorsNew onset delirium

Series1

Series2

Series3

0

0.2

0.4

0.6

0.8

1

1.2

Pneu

mon

iaFever >

102

F and

at

New

or increased

Pu

lse >1

00;

Rigors

Delirium

Respira

tory

rate

>25

Afeb

rile reside

nt with

Afeb

rile reside

nt

Respira

tory

rate

>25

Delirium

Prod

uctiv

e cough

Chest Xray

and

Co

ugh

pulse >100

worsening

men

tal

rigors

Series1

Series2

Series3

29

New Fever 2.4F increase above infiltrate on chest X-ray thought to represent pneumonia baseline temperature Productive cough

Chest X-ray and complete cell count with differential is reasonable for residents with fever

Cough

AND at least one of the following

pulse >100

worsening mental status

rigors

Total Records Reviewed

Total Criteria Met

%

a) Antibiotic #1

Enter # Days of Therapy (DOT) (a)

b) Antibiotic #2

Enter # Days of Therapy (DOT) (b)

c) Antibiotic #3

Enter # Days of Therapy (DOT) (c )

d) Antibiotic #4

Enter # Days of Therapy (DOT) (d)

e. Antibiotic #5

Enter #Days of Therapy (DOT) (e)

Days of Therapy Total Total % Total Days of Therapy (DOT) (a-e)

Antibiotic Consumption: Which antibiotic was ordered? [The user should edit the specific antibiotic(s) within the class below used in their facility. i.e. Fluoroquinolones - enter levofloxacin, if more than one fluoroquinolone copy the row and add to the tool.] and Days of Therapy.

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met %

Total Days of Therapy (DOT) (ae)

Total Days of Therapy (DOT) (ae)

30

Outcome of Therapy Total Records Reviewed

Total Criteria Met

%

Clinical Improvement? T < 38C, systolic BP >90 mmHg, RR

Review/Audit of Antibiotic Use, Orders and Policies/Protocols Year: AUDIT RECORDING FORM

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Total Records Reviewed

Total Criteria Met

%

Recorded Information

Was Antibiotic Use Appropriate? Total Records

Total Criteria %

Do you have an Antibiotic Protocol or Treatment Guidelines which you followed? Was a clinical diagnosis of the problem recorded? Did the antibiotic order include appropriate dose? Did the antibiotic order include the appropriate frequency?

Was the duration of antibotic included in the order?

Was appropriate monitoring (drug levels - if no TDM is necessary leave this blank) Was appropriate antibiotic organ system monitoring obtained? (renal, hepatic)

Was a C&S obtained OR if prior C&S, diagnosis is documented in the record (osteomyelitis, central line infection, etc.)? Was the organism sensitive to the prescribed antibiotic? Was the antibiotic changed to directed therapy once C&S results were available = within 72-96 hours)?

Was there unnecessary duplicate antibiotic therapy?

Were criteria for restricted antibiotic use met, i.e prior approval /authorization?

Month: Review 10 to 20 patients residents who have recently had antibiotics ordered/prescribed. Facility AbStewardship Team Determine and Select the Measures to be Audited. The facility may select all or only a few of the measures. Each number, 1- 20 represents a resident reviewed. Enter Yes or No for each measure your team selects for review (rows 7 - 92). Under the number, you may desire to enter the resident initial or identifier for later reference.

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met

%

32

Where any of the following clinical features present?

Total Records Reviewed

Total Criteria Met

%

Skin/Soft tissue Infection (Loeb)

New or increasing purulent drainage at a wound, skin, or soft-tissue site OR at least 2 of the following

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature) Redness

Tenderness

Warmth

New or increasing swelling

UTI

Acute dysuria

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature) New or worsening: Urinary incontinence and/or

Urgency and/or

Frequency and/or

Suprapubic pain and/or

Gross hematuria and/or

Costovertebral angle tenderness

UTI with indwelling catheter (catheter associated UTI) (Loeb Criteria) at least one of the following Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature New costovertebral tenderness

Rigors

New onset delirium

Pneumonia

Fever > 102 F and at least one of the following: Fever 2.4F increase above baseline temperature, and cough and at least one of the following: AND at least one of the following

New or increased cough

Pulse >100;

Rigors

Delirium

Respiratory rate >25 OR

Afebrile resident with COPD and >65 years and new or increased cough with purulent sputum production OR

Afebrile resident without COPD and new cough with purulent sputum production and at least one of the following:

AND at least one of the following

Respiratory rate >25 OR

Delirium

In patients with spinal cord injury, fever, pain over

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met

%

0

0.2

0.4

0.6

0.8

1

1.2

Series1

Series2

Series3

kidney or bladder during urination, onset of urinary incontinence, increased spascity, autonomic dysreflexia or sense of unease may be comparable with CAUTI

0

0.2

0.4

0.6

0.8

1

1.2

UTI with indwelling catheter (catheter associated UTI) (Loeb Criteria) at least one of the following

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature New costovertebral tendernessRigorsNew onset delirium

Series1

Series2

Series3

0

0.2

0.4

0.6

0.8

1

1.2

Pneu

mon

iaFever >

102

F and

at

New

or increased

Pu

lse >1

00;

Rigors

Delirium

Respira

tory

rate

>25

Afeb

rile reside

nt with

Afeb

rile reside

nt

Respira

tory

rate

>25

Delirium

Prod

uctiv

e cough

Chest Xray

and

Co

ugh

pulse >100

worsening

men

tal

rigors

Series1

Series2

Series3

33

New Fever 2.4F increase above infiltrate on chest X-ray thought to represent pneumonia baseline temperature Productive cough

Chest X-ray and complete cell count with differential is reasonable for residents with fever

Cough

AND at least one of the following

pulse >100

worsening mental status

rigors

Total Records Reviewed

Total Criteria Met

%

a) Antibiotic #1

Enter # Days of Therapy (DOT) (a)

b) Antibiotic #2

Enter # Days of Therapy (DOT) (b)

c) Antibiotic #3

Enter # Days of Therapy (DOT) (c )

d) Antibiotic #4

Enter # Days of Therapy (DOT) (d)

e. Antibiotic #5

Enter #Days of Therapy (DOT) (e)

Days of Therapy Total Total % Total Days of Therapy (DOT) (a-e)

Antibiotic Consumption: Which antibiotic was ordered? [The user should edit the specific antibiotic(s) within the class below used in their facility. i.e. Fluoroquinolones - enter levofloxacin, if more than one fluoroquinolone copy the row and add to the tool.] and Days of Therapy.

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met %

Total Days of Therapy (DOT) (ae)

Total Days of Therapy (DOT) (ae)

34

Outcome of Therapy Total Records Reviewed

Total Criteria Met

%

Clinical Improvement? T < 38C, systolic BP >90 mmHg, RR

Review/Audit of Antibiotic Use, Orders and Policies/Protocols Year: AUDIT RECORDING FORM

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Total Records Reviewed

Total Criteria Met

%

Recorded Information

Was Antibiotic Use Appropriate? Total Records

Total Criteria %

Do you have an Antibiotic Protocol or Treatment Guidelines which you followed? Was a clinical diagnosis of the problem recorded? Did the antibiotic order include appropriate dose? Did the antibiotic order include the appropriate frequency?

Was the duration of antibotic included in the order?

Was appropriate monitoring (drug levels - if no TDM is necessary leave this blank) Was appropriate antibiotic organ system monitoring obtained? (renal, hepatic)

Was a C&S obtained OR if prior C&S, diagnosis is documented in the record (osteomyelitis, central line infection, etc.)? Was the organism sensitive to the prescribed antibiotic? Was the antibiotic changed to directed therapy once C&S results were available = within 72-96 hours)?

Was there unnecessary duplicate antibiotic therapy?

Were criteria for restricted antibiotic use met, i.e prior approval /authorization?

Month: Review 10 to 20 patients residents who have recently had antibiotics ordered/prescribed. Facility AbStewardship Team Determine and Select the Measures to be Audited. The facility may select all or only a few of the measures. Each number, 1- 20 represents a resident reviewed. Enter Yes or No for each measure your team selects for review (rows 7 - 92). Under the number, you may desire to enter the resident initial or identifier for later reference.

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met

%

36

Where any of the following clinical features present?

Total Records Reviewed

Total Criteria Met

%

Skin/Soft tissue Infection (Loeb)

New or increasing purulent drainage at a wound, skin, or soft-tissue site OR at least 2 of the following

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature) Redness

Tenderness

Warmth

New or increasing swelling

UTI

Acute dysuria

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature) New or worsening: Urinary incontinence and/or

Urgency and/or

Frequency and/or

Suprapubic pain and/or

Gross hematuria and/or

Costovertebral angle tenderness

UTI with indwelling catheter (catheter associated UTI) (Loeb Criteria) at least one of the following Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature New costovertebral tenderness

Rigors

New onset delirium

Pneumonia

Fever > 102 F and at least one of the following: Fever 2.4F increase above baseline temperature, and cough and at least one of the following: AND at least one of the following

New or increased cough

Pulse >100;

Rigors

Delirium

Respiratory rate >25 OR

Afebrile resident with COPD and >65 years and new or increased cough with purulent sputum production OR

Afebrile resident without COPD and new cough with purulent sputum production and at least one of the following:

AND at least one of the following

Respiratory rate >25 OR

Delirium

In patients with spinal cord injury, fever, pain over

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met

%

0

0.2

0.4

0.6

0.8

1

1.2

Series1

Series2

Series3

kidney or bladder during urination, onset of urinary incontinence, increased spascity, autonomic dysreflexia or sense of unease may be comparable with CAUTI

0

0.2

0.4

0.6

0.8

1

1.2

UTI with indwelling catheter (catheter associated UTI) (Loeb Criteria) at least one of the following

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature New costovertebral tendernessRigorsNew onset delirium

Series1

Series2

Series3

0

0.2

0.4

0.6

0.8

1

1.2

Pneu

mon

iaFever >

102

F and

at

New

or increased

Pu

lse >1

00;

Rigors

Delirium

Respira

tory

rate

>25

Afeb

rile reside

nt with

Afeb

rile reside

nt

Respira

tory

rate

>25

Delirium

Prod

uctiv

e cough

Chest Xray

and

Co

ugh

pulse >100

worsening

men

tal

rigors

Series1

Series2

Series3

37

New Fever 2.4F increase above infiltrate on chest X-ray thought to represent pneumonia baseline temperature Productive cough

Chest X-ray and complete cell count with differential is reasonable for residents with fever

Cough

AND at least one of the following

pulse >100

worsening mental status

rigors

Total Records Reviewed

Total Criteria Met

%

a) Antibiotic #1

Enter # Days of Therapy (DOT) (a)

b) Antibiotic #2

Enter # Days of Therapy (DOT) (b)

c) Antibiotic #3

Enter # Days of Therapy (DOT) (c )

d) Antibiotic #4

Enter # Days of Therapy (DOT) (d)

e. Antibiotic #5

Enter #Days of Therapy (DOT) (e)

Days of Therapy Total Total % Total Days of Therapy (DOT) (a-e)

Antibiotic Consumption: Which antibiotic was ordered? [The user should edit the specific antibiotic(s) within the class below used in their facility. i.e. Fluoroquinolones - enter levofloxacin, if more than one fluoroquinolone copy the row and add to the tool.] and Days of Therapy.

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met %

Total Days of Therapy (DOT) (ae)

Total Days of Therapy (DOT) (ae)

38

Outcome of Therapy Total Records Reviewed

Total Criteria Met

%

Clinical Improvement? T < 38C, systolic BP >90 mmHg, RR

Review/Audit of Antibiotic Use, Orders and Policies/Protocols Year: AUDIT RECORDING FORM

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Total Records Reviewed

Total Criteria Met

%

Recorded Information

Was Antibiotic Use Appropriate? Total Records

Total Criteria %

Do you have an Antibiotic Protocol or Treatment Guidelines which you followed? Was a clinical diagnosis of the problem recorded? Did the antibiotic order include appropriate dose? Did the antibiotic order include the appropriate frequency?

Was the duration of antibotic included in the order?

Was appropriate monitoring (drug levels - if no TDM is necessary leave this blank) Was appropriate antibiotic organ system monitoring obtained? (renal, hepatic)

Was a C&S obtained OR if prior C&S, diagnosis is documented in the record (osteomyelitis, central line infection, etc.)? Was the organism sensitive to the prescribed antibiotic? Was the antibiotic changed to directed therapy once C&S results were available = within 72-96 hours)?

Was there unnecessary duplicate antibiotic therapy?

Were criteria for restricted antibiotic use met, i.e prior approval /authorization?

Month: Review 10 to 20 patients residents who have recently had antibiotics ordered/prescribed. Facility AbStewardship Team Determine and Select the Measures to be Audited. The facility may select all or only a few of the measures. Each number, 1- 20 represents a resident reviewed. Enter Yes or No for each measure your team selects for review (rows 7 - 92). Under the number, you may desire to enter the resident initial or identifier for later reference.

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met

%

40

Where any of the following clinical features present?

Total Records Reviewed

Total Criteria Met

%

Skin/Soft tissue Infection (Loeb)

New or increasing purulent drainage at a wound, skin, or soft-tissue site OR at least 2 of the following

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature) Redness

Tenderness

Warmth

New or increasing swelling

UTI

Acute dysuria

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature) New or worsening: Urinary incontinence and/or

Urgency and/or

Frequency and/or

Suprapubic pain and/or

Gross hematuria and/or

Costovertebral angle tenderness

UTI with indwelling catheter (catheter associated UTI) (Loeb Criteria) at least one of the following Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature New costovertebral tenderness

Rigors

New onset delirium

Pneumonia

Fever > 102 F and at least one of the following: Fever 2.4F increase above baseline temperature, and cough and at least one of the following: AND at least one of the following

New or increased cough

Pulse >100;

Rigors

Delirium

Respiratory rate >25 OR

Afebrile resident with COPD and >65 years and new or increased cough with purulent sputum production OR

Afebrile resident without COPD and new cough with purulent sputum production and at least one of the following:

AND at least one of the following

Respiratory rate >25 OR

Delirium

In patients with spinal cord injury, fever, pain over

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met

%

0

0.2

0.4

0.6

0.8

1

1.2

Series1

Series2

Series3

kidney or bladder during urination, onset of urinary incontinence, increased spascity, autonomic dysreflexia or sense of unease may be comparable with CAUTI

0

0.2

0.4

0.6

0.8

1

1.2

UTI with indwelling catheter (catheter associated UTI) (Loeb Criteria) at least one of the following

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature New costovertebral tendernessRigorsNew onset delirium

Series1

Series2

Series3

0

0.2

0.4

0.6

0.8

1

1.2

Pneu

mon

iaFever >

102

F and

at

New

or increased

Pu

lse >1

00;

Rigors

Delirium

Respira

tory

rate

>25

Afeb

rile reside

nt with

Afeb

rile reside

nt

Respira

tory

rate

>25

Delirium

Prod

uctiv

e cough

Chest Xray

and

Co

ugh

pulse >100

worsening

men

tal

rigors

Series1

Series2

Series3

41

New Fever 2.4F increase above infiltrate on chest X-ray thought to represent pneumonia baseline temperature Productive cough

Chest X-ray and complete cell count with differential is reasonable for residents with fever

Cough

AND at least one of the following

pulse >100

worsening mental status

rigors

Total Records Reviewed

Total Criteria Met

%

a) Antibiotic #1

Enter # Days of Therapy (DOT) (a)

b) Antibiotic #2

Enter # Days of Therapy (DOT) (b)

c) Antibiotic #3

Enter # Days of Therapy (DOT) (c )

d) Antibiotic #4

Enter # Days of Therapy (DOT) (d)

e. Antibiotic #5

Enter #Days of Therapy (DOT) (e)

Days of Therapy Total Total % Total Days of Therapy (DOT) (a-e)

Antibiotic Consumption: Which antibiotic was ordered? [The user should edit the specific antibiotic(s) within the class below used in their facility. i.e. Fluoroquinolones - enter levofloxacin, if more than one fluoroquinolone copy the row and add to the tool.] and Days of Therapy.

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met %

Total Days of Therapy (DOT) (ae)

Total Days of Therapy (DOT) (ae)

42

Outcome of Therapy Total Records Reviewed

Total Criteria Met

%

Clinical Improvement? T < 38C, systolic BP >90 mmHg, RR

Review/Audit of Antibiotic Use, Orders and Policies/Protocols Year: AUDIT RECORDING FORM

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Total Records Reviewed

Total Criteria Met

%

Recorded Information

Was Antibiotic Use Appropriate? Total Records

Total Criteria %

Do you have an Antibiotic Protocol or Treatment Guidelines which you followed? Was a clinical diagnosis of the problem recorded? Did the antibiotic order include appropriate dose? Did the antibiotic order include the appropriate frequency?

Was the duration of antibotic included in the order?

Was appropriate monitoring (drug levels - if no TDM is necessary leave this blank) Was appropriate antibiotic organ system monitoring obtained? (renal, hepatic)

Was a C&S obtained OR if prior C&S, diagnosis is documented in the record (osteomyelitis, central line infection, etc.)? Was the organism sensitive to the prescribed antibiotic? Was the antibiotic changed to directed therapy once C&S results were available = within 72-96 hours)?

Was there unnecessary duplicate antibiotic therapy?

Were criteria for restricted antibiotic use met, i.e prior approval /authorization?

Month: Review 10 to 20 patients residents who have recently had antibiotics ordered/prescribed. Facility AbStewardship Team Determine and Select the Measures to be Audited. The facility may select all or only a few of the measures. Each number, 1- 20 represents a resident reviewed. Enter Yes or No for each measure your team selects for review (rows 7 - 92). Under the number, you may desire to enter the resident initial or identifier for later reference.

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met

%

44

Where any of the following clinical features present?

Total Records Reviewed

Total Criteria Met

%

Skin/Soft tissue Infection (Loeb)

New or increasing purulent drainage at a wound, skin, or soft-tissue site OR at least 2 of the following

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature) Redness

Tenderness

Warmth

New or increasing swelling

UTI

Acute dysuria

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature) New or worsening: Urinary incontinence and/or

Urgency and/or

Frequency and/or

Suprapubic pain and/or

Gross hematuria and/or

Costovertebral angle tenderness

UTI with indwelling catheter (catheter associated UTI) (Loeb Criteria) at least one of the following Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature New costovertebral tenderness

Rigors

New onset delirium

Pneumonia

Fever > 102 F and at least one of the following: Fever 2.4F increase above baseline temperature, and cough and at least one of the following: AND at least one of the following

New or increased cough

Pulse >100;

Rigors

Delirium

Respiratory rate >25 OR

Afebrile resident with COPD and >65 years and new or increased cough with purulent sputum production OR

Afebrile resident without COPD and new cough with purulent sputum production and at least one of the following:

AND at least one of the following

Respiratory rate >25 OR

Delirium

In patients with spinal cord injury, fever, pain over

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met

%

0

0.2

0.4

0.6

0.8

1

1.2

Series1

Series2

Series3

kidney or bladder during urination, onset of urinary incontinence, increased spascity, autonomic dysreflexia or sense of unease may be comparable with CAUTI

0

0.2

0.4

0.6

0.8

1

1.2

UTI with indwelling catheter (catheter associated UTI) (Loeb Criteria) at least one of the following

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature New costovertebral tendernessRigorsNew onset delirium

Series1

Series2

Series3

0

0.2

0.4

0.6

0.8

1

1.2

Pneu

mon

iaFever >

102

F and

at

New

or increased

Pu

lse >1

00;

Rigors

Delirium

Respira

tory

rate

>25

Afeb

rile reside

nt with

Afeb

rile reside

nt

Respira

tory

rate

>25

Delirium

Prod

uctiv

e cough

Chest Xray

and

Co

ugh

pulse >100

worsening

men

tal

rigors

Series1

Series2

Series3

45

New Fever 2.4F increase above infiltrate on chest X-ray thought to represent pneumonia baseline temperature Productive cough

Chest X-ray and complete cell count with differential is reasonable for residents with fever

Cough

AND at least one of the following

pulse >100

worsening mental status

rigors

Total Records Reviewed

Total Criteria Met

%

a) Antibiotic #1

Enter # Days of Therapy (DOT) (a)

b) Antibiotic #2

Enter # Days of Therapy (DOT) (b)

c) Antibiotic #3

Enter # Days of Therapy (DOT) (c )

d) Antibiotic #4

Enter # Days of Therapy (DOT) (d)

e. Antibiotic #5

Enter #Days of Therapy (DOT) (e)

Days of Therapy Total Total % Total Days of Therapy (DOT) (a-e)

Antibiotic Consumption: Which antibiotic was ordered? [The user should edit the specific antibiotic(s) within the class below used in their facility. i.e. Fluoroquinolones - enter levofloxacin, if more than one fluoroquinolone copy the row and add to the tool.] and Days of Therapy.

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met %

Total Days of Therapy (DOT) (ae)

Total Days of Therapy (DOT) (ae)

46

Outcome of Therapy Total Records Reviewed

Total Criteria Met

%

Clinical Improvement? T < 38C, systolic BP >90 mmHg, RR

Review/Audit of Antibiotic Use, Orders and Policies/Protocols Year: AUDIT RECORDING FORM

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Total Records Reviewed

Total Criteria Met

%

Recorded Information

Was Antibiotic Use Appropriate? Total Records

Total Criteria %

Do you have an Antibiotic Protocol or Treatment Guidelines which you followed? Was a clinical diagnosis of the problem recorded? Did the antibiotic order include appropriate dose? Did the antibiotic order include the appropriate frequency?

Was the duration of antibotic included in the order?

Was appropriate monitoring (drug levels - if no TDM is necessary leave this blank) Was appropriate antibiotic organ system monitoring obtained? (renal, hepatic)

Was a C&S obtained OR if prior C&S, diagnosis is documented in the record (osteomyelitis, central line infection, etc.)? Was the organism sensitive to the prescribed antibiotic? Was the antibiotic changed to directed therapy once C&S results were available = within 72-96 hours)?

Was there unnecessary duplicate antibiotic therapy?

Were criteria for restricted antibiotic use met, i.e prior approval /authorization?

Month: Review 10 to 20 patients residents who have recently had antibiotics ordered/prescribed. Facility AbStewardship Team Determine and Select the Measures to be Audited. The facility may select all or only a few of the measures. Each number, 1- 20 represents a resident reviewed. Enter Yes or No for each measure your team selects for review (rows 7 - 92). Under the number, you may desire to enter the resident initial or identifier for later reference.

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met

%

48

Where any of the following clinical features present?

Total Records Reviewed

Total Criteria Met

%

Skin/Soft tissue Infection (Loeb)

New or increasing purulent drainage at a wound, skin, or soft-tissue site OR at least 2 of the following

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature) Redness

Tenderness

Warmth

New or increasing swelling

UTI

Acute dysuria

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature) New or worsening: Urinary incontinence and/or

Urgency and/or

Frequency and/or

Suprapubic pain and/or

Gross hematuria and/or

Costovertebral angle tenderness

UTI with indwelling catheter (catheter associated UTI) (Loeb Criteria) at least one of the following Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature New costovertebral tenderness

Rigors

New onset delirium

Pneumonia

Fever > 102 F and at least one of the following: Fever 2.4F increase above baseline temperature, and cough and at least one of the following: AND at least one of the following

New or increased cough

Pulse >100;

Rigors

Delirium

Respiratory rate >25 OR

Afebrile resident with COPD and >65 years and new or increased cough with purulent sputum production OR

Afebrile resident without COPD and new cough with purulent sputum production and at least one of the following:

AND at least one of the following

Respiratory rate >25 OR

Delirium

In patients with spinal cord injury, fever, pain over

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met

%

0

0.2

0.4

0.6

0.8

1

1.2

Series1

Series2

Series3

kidney or bladder during urination, onset of urinary incontinence, increased spascity, autonomic dysreflexia or sense of unease may be comparable with CAUTI

0

0.2

0.4

0.6

0.8

1

1.2

UTI with indwelling catheter (catheter associated UTI) (Loeb Criteria) at least one of the following

Fever (>37.9C [100F] or a 1.5C [2.4F] increase above baseline temperature New costovertebral tendernessRigorsNew onset delirium

Series1

Series2

Series3

0

0.2

0.4

0.6

0.8

1

1.2

Pneu

mon

iaFever >

102

F and

at

New

or increased

Pu

lse >1

00;

Rigors

Delirium

Respira

tory

rate

>25

Afeb

rile reside

nt with

Afeb

rile reside

nt

Respira

tory

rate

>25

Delirium

Prod

uctiv

e cough

Chest Xray

and

Co

ugh

pulse >100

worsening

men

tal

rigors

Series1

Series2

Series3

49

New Fever 2.4F increase above infiltrate on chest X-ray thought to represent pneumonia baseline temperature Productive cough

Chest X-ray and complete cell count with differential is reasonable for residents with fever

Cough

AND at least one of the following

pulse >100

worsening mental status

rigors

Total Records Reviewed

Total Criteria Met

%

a) Antibiotic #1

Enter # Days of Therapy (DOT) (a)

b) Antibiotic #2

Enter # Days of Therapy (DOT) (b)

c) Antibiotic #3

Enter # Days of Therapy (DOT) (c )

d) Antibiotic #4

Enter # Days of Therapy (DOT) (d)

e. Antibiotic #5

Enter #Days of Therapy (DOT) (e)

Days of Therapy Total Total % Total Days of Therapy (DOT) (a-e)

Antibiotic Consumption: Which antibiotic was ordered? [The user should edit the specific antibiotic(s) within the class below used in their facility. i.e. Fluoroquinolones - enter levofloxacin, if more than one fluoroquinolone copy the row and add to the tool.] and Days of Therapy.

0

0.2

0.4

0.6

0.8

1

1.2

Total Records Reviewed

Total Criteria Met %

Total Days of Therapy (DOT) (ae)

Total Days of Therapy (DOT) (ae)

50

Outcome of Therapy Total Records Reviewed

Total Criteria Met

%

Clinical Improvement? T < 38C, systolic BP >90 mmHg, RR

Response Antimicrobials Yes amoxicillin

No ampicillin

penicillin G amoxicilllin/clavulanate

ampicilline/sulbactam piperacillin/tazobactam ticarcillin/clavulanate cefaclor cefadroxil cefazolin cefepime cefixime cefotaxime cefotetan cefoxitin cefprozil ceftazidime ceftibuten ceftidoren ceftriaxone cefuroxime cephalexin ceftaroline (Teflaro) ceftazidime-avabactam (Avycaz) ceftolozone-tazobactam (Zerbaxa) colistin doripenem imipenem meropenem erythromicin clarithromycin azithromycin telithromycin ciprofloxacin gemifloxacin levofloxacin moxifloxacin norfloxacin ofloxacin clindamycin metronidazole doxicycline minocycline tetracycline trimethoprim-sulfamethoxazone (TMP-SMZ) daptomycin (Cubicin) dalbavancin (Dalvance) oritavancin (Orbactiv) telavancin (Vibativ) vancomycin linezolid (Zyvox) tedizolid (Sivextro) quinupristin-dalfopristin (Syndercid) fluconazole itraconazole posaconazole (Noxafil) voriconazole (Vfend) caspofungin (Candidas) micafungin (Mycamine) anidulafungin (Eraxis) amphotericin B

52

Review/Audit of Antibiotic Use, Orders and Policies/Protocols Audit Tool and ReportingReferences:Antimicrobial Stewardship Quality & Performance MeasuresMeasurementProcess MeasuresOutcome Measures:

REPORTING INFORMATION TO STAFF ON IMPROVING ANTIBIOTIC USE AND RESISTANCEReferences:

Appendix. Example Audit ToolsEXAMPLES OF SIMILAR AUDIT TOOLS COMPLETED

Review/Audit of Antibiotic Use, Orders and Policies/ProtocolsAUDIT RECORDING FORM

Review/Audit of Antibiotic Use, Orders and Policies/ProtocolsAUDIT RECORDING FORM

Review/Audit of Antibiotic Use, Orders and Policies/ProtocolsAUDIT RECORDING FORM

Review/Audit of Antibiotic Use, Orders and Policies/ProtocolsAUDIT RECORDING FORM

Review/Audit of Antibiotic Use, Orders and Policies/ProtocolsAUDIT RECORDING FORM

Review/Audit of Antibiotic Use, Orders and Policies/ProtocolsAUDIT RECORDING FORM

Review/Audit of Antibiotic Use, Orders and Policies/ProtocolsAUDIT RECORDING FORM

Review/Audit of Antibiotic Use, Orders and Policies/ProtocolsAUDIT RECORDING FORM

Review/Audit of Antibiotic Use, Orders and Policies/ProtocolsAUDIT RECORDING FORM

Review/Audit of Antibiotic Use, Orders and Policies/ProtocolsAUDIT RECORDING FORM

Review/Audit of Antibiotic Use, Orders and Policies/ProtocolsAUDIT RECORDING FORM

Review/Audit of Antibiotic Use, Orders and Policies/ProtocolsAUDIT RECORDING FORM

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