Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
6/19/2018 version
Please fill each row out on the "Facility ABX Data" tab for any patient who is
started on antibiotics for an infection.
• If the same patient was started on more than one antibiotic for the same
infection, record each antibiotic on a separate row.
• Every time an antibiotic is stopped and restarted, start that antibiotic
again on a new row.
• Ideally the information needed to complete this form will be obtained
from the 24 hour report and chart review.
• Use drop down choices as much as possible. If your choice is not listed
on the drop down menu, then type in your response.
• Any columns not highlighted or from "O" to "AB" may be hidden if the
data is not going to be currently tracked. This may help reduce the size of the
tool and eliminate unwanted columns.
• Yellow Highlighted columns are used for calculations, do not hide these
columns if reducing size of data collection
Manually enter Patient Days Present data on the
second tab in order to calculate ABX Rate, DOT Rate
and ABX by Prescriber
(For any column on the "Facility ABX Data" tab that has a drop-down menu available
Go to Drop Down Selections " tab (columns are in same order as on the "Facility AB
tab)
• To add additional selections: click on next available blank cell under the desired
heading and enter new selection- the box indicated the number of available fields fo
column
• To delete or edit current selections: highlight cell in list and type in new selecti
• New selections should automatically appear in drop down menus on "Facility A
tab
• Columns filled in grey align with NHSN definitions- do not recommend changing
selections
a on the
ate, DOT Rate
ymptom Criteria
prostate
w or increased) :
Instructions for "Days Present by
For patient care location-specific analyses, day
calculated as the number of patients who wer
portion of each day of a calendar month in an
location.
Additional Symptoms (list) Urinary Catheter Do the Urinary Symptoms Fit the McGeer Criteria or
(Y/N) NHSN Criteria (see "Instructions") (Y/N)
Pharmacy Recommendations
Accepted (Y/N/NA)
YES
Days Present per month- Acute Care (includes
Month Obs, Acute/Med Surg, Swing) Days Present per month- LTC
January 465 775
February 434 775
March 445 775
April 425 775
May 427 775
June
July
August
September
October
November
December
Patient Location Upon Date Admitted to Patient Status upon During stay, if patient
Patient Name Admit Hospital Admit status changed, what to?
Acute Care (Obs, Acute,
Med/Surg, Skilled Swing,
OB) Acute Care/Med Surg Acute Care/Med Surg
LTC Observation Observation
Cephalosporins
CEFTAZIDIME/ AVIBACTAM Β-lactam/ Β-lactamase inhibitor
combination
CEFTIBUTEN Cephalosporins
CEFTIZOXIME Cephalosporins
CEFTOLOZANE/ TAZOBACTAM Β-lactam/ Β-lactamase inhibitor
combination
CEFTRIAXONE Cephalosporins
CEFUROXIME Cephalosporins
CEPHALEXIN Cephalosporins
CHLORAMPHENICOL Phenicols
CIPROFLOXACIN Fluoroquinolones
CLARITHROMYCIN Macrolides
CLINDAMYCIN Lincosamides
COLISTIMETHATE Polymyxins
DALBAVANCIN Glycopeptides
DAPTOMYCIN Lipopeptides
DICLOXACILLIN Penicillins
DORIPENEM Carbapenems
DOXYCYCLINE Tetracyclines
ERTAPENEM Carbapenems
ERYTHROMYCIN Macrolides
ERYTHROMYCIN/
SULFISOXAZOLE Folate pathway inhibitors
FIDAXOMICIN Macrocyclic
FLUCONAZOLE Azoles
FOSFOMYCIN Fosfomycins
GEMIFLOXACIN Fluoroquinolones
GENTAMICIN Aminoglycosides
IMIPENEM/ CILASTATIN Carbapenems
ISAVUCONAZONIUM Azoles
ITRACONAZOLE Azoles
LEVOFLOXACIN Fluoroquinolones
LINEZOLID Oxazolidinones
MEROPENEM Carbapenems
METRONIDAZOLE Nitroimidazoles
MICAFUNGIN Echinocandins
MINOCYCLINE Tetracyclines
MOXIFLOXACIN Fluoroquinolones
NAFCILLIN Penicillins
NITROFURANTOIN Nitrofurans
ORITAVANCIN Glycopeptides
OSELTAMIVIR Neuraminidase inhibitors
OXACILLIN Penicillins
PENICILLIN G Penicillins
PENICILLIN V Penicillins
PERAMIVIR Neuraminidase inhibitors
PIPERACILLIN Penicillins
PIPERACILLIN/ TAZOBACTAM Β-lactam/ Β-lactamase inhibitor
combination
POLYMYXIN B Polymyxins
POSACONAZOLE Azoles
QUINUPRISTIN/ DALFOPRISTIN Streptogramins
RIFAMPIN Rifampin
RIMANTADINE M2 ion channel inhibitors
SULFAMETHOXAZOLE/
TRIMETHOPRIM Folate pathway inhibitors
SULFISOXAZOLE Folate pathway inhibitors
TEDIZOLID Oxazolidinones
TELAVANCIN Glycopeptides
TELITHROMYCIN Ketolides
TETRACYCLINE Tetracyclines
TICARCILLIN/ CLAVULANATE Β-lactam/ Β-lactamase inhibitor
combination
TIGECYCLINE Glycylcyclines
TINIDAZOLE Nitroimidazoles
TOBRAMYCIN Aminoglycosides
VANCOMYCIN Glycopeptides
VORICONAZOLE Azoles
ZANAMIVIR Neuraminidase inhibitors
ed within the box) or remove items
ew data or clearing the contents.
.
d with NHSN
IV
Dr. 1
IM Dr. 2
Digestive
Dr. 3
Respiratory
Dr. 4
Do Not Change- Aligned with NHSN
Swelling or inflamation
Urinary tract symptoms
Vomiting
Wheezing
Other
Urinary Do the Urinary Symptoms Fit the
Additional Symptoms Catheter McGeer Criteria (see green box) or
(list) (Y/N) NHSN Criteria WBC count Source of Culture
Sputum
Stool
Urine
Colony Count (amount of
Culture Results Culture Results organism growing)
Enterococcus Enterococcus
IV to PO NA
Do not enter any data in these green
tables; if you have entered data in the
Facility Template and Days Present tabs,
the tables will be automatically populated.
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May
Patient Location Upon Admit - all - Click Refresh each time you look at the graphs Patient Location Upon Admit
to make sure any newly entered data has been
updated. To do this, right click anywhere on
Months Count - ABX Start Date these data tables. Then select "Refresh". Months
Feb Feb
Dec 1 Dec
Total Result 1 Total Result
Total ABX Start Date Patient Days Present-LTC Rate Per 1000
0 775 0.00
775 0.00
0 775 0.00
0 775 0.00
0 775 0.00
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
0 0 #DIV/0!
ABX Rate Per 1000-LTC
0.00 0.00
Apr May Jun Jul Aug Sep Oct Nov Dec
- all -
1
1
Do not enter any data in
these green tables; if you
have entered data in the
Facility Template and Days
Present tabs, the tables will
be automatically
Patie populated.
nt
Days
Month DOT/Month Prese Rate/1000
nt-
Jan 0 Acute
465 0.00 January
Care
Feb 0 434 0.00 February
Mar 0 445 0.00 March
Apr 0 425 0.00 April
May 0 427 0.00 May
Jun 0 0 #DIV/0! June
Jul 0 0 #DIV/0! July
Aug 0 0 #DIV/0! August
Sep 0 0 #DIV/0! Septemb
Oct 0 0 #DIV/0! October
Nov 0 0 #DIV/0! Novembe
Dec 0 0 #DIV/0! Decembe
Rate/1000
Rate/1000
Sum - DOT
3643
Antibiotics/Month by Prescribe
3600
3450
3300
3150
3000
2850
2700
2550
2400
2250
2100
1950
1800
1650
1500
1350
1200
1050
900
750
600
450
300
150
0
Select ABX
(empty)
Select ABX
10
0
Β-lactam/ Β-lactamase inhibitor combination
Antibiotic Class Count - Antibiotic Class Click Refresh each time you look at the graphs to make
sure any newly entered data has been updated. To do
#N/A 3633 this, right click anywhere on these data tables. Then
Β-lactam/ Β-lactamase inhibit 1 select "Refresh".
Total Result 3634
ation
mbination