How to Investigate Drug Use in Health Facilities: Selected Drug Use Indicators - EDM Research Series No. 007: Annexes: Annex 2: Data collection forms

How to Investigate Drug Use in Health Facilities: Selected Drug Use Indicators - EDM Research Series No. 007
(1993; 92 pages) [French] [Spanish]

Table of Contents

	Introduction
		Purpose of drug use indicators
		Objectives of a drug use study
		Background on the development of drug use indicators
		Contents of the manual
		Comments on the manual
	Chapter 1: Overview
		Types of indicators
		Types of drug use studies with indicators
		Steps in organizing and carrying out a drug use study with indicators
	Chapter 2: Core drug use indicators
		Group 1: Prescribing indicators
		Group 2: Patient care indicators
		Group 3: Health facility indicators
	Chapter 3: Study design and sample size
		Select the type of facilities for the study
		Define the types of prescribing encounters to be included
		Choose between retrospective and prospective data
		Sample size
	Chapter 4: Planning and field methods
		Personnel requirements
		Preparations for field work
		Data collection in the field
		Coding of the indicators
	Chapter 5: Analysis and reporting
		Calculating results for each facility
		Displaying the results
		Reporting results at the facility
		Reporting at the administrative level
		Results of earlier drug use studies
	Chapter 6: Follow up questions
		General directions
		Follow-up questions for specific indicators
	Annexes
		Annex 1: Sampling procedures
		Annex 2: Data collection forms
		Annex 3: Examples of earlier studies
		Annex 4: Using the indicators for monitoring
		Annex 5: Complementary drug use indicators
		Annex 6: References

Annex 2: Data collection forms

Form 1: Prescribing indicator form

Form 2: Detailed indicators encounter form

Form 3: Patient care form

Form 4: Facility summary form

Form 5: Facility indicator reporting form

Form 6: Drug use indicators consolidation form

PRESCRIBING INDICATOR FORM

Location: ________________________________________

Investigator: ____________________ Date: ____________

Seq. #	Type (R/P)	Date of Rx	Age (yrs)	# Drugs	# Generics	Antib. (0/1)^*	Injec. (0/1)^*	# on EDL	Diagnosis (Optional)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Total
Average
Percentage					% *of total drugs*	% *of total cases*	% *of total cases*	% *of total drugs*

^* 0 = No 1 = Yes

DETAILED INDICATORS ENCOUNTER FORM

Location: ________________________________________

Investigator: ____________________ Date: ____________

ID #	Date	Name	Age	Sex	Prescriber

Health Problems	Health Problem Description		Code
	1.
	2.
	3.

Drugs	Name and Strength		Code		Quantity
	1.
	2.
	3.
	4.
	5.
	6.
	7.
	8.
	9.
	10.

ID #	Date	Name	Age	Sex	Prescriber

Health Problems	Health Problem Description		Code
	1.
	2.
	3.

Drugs	Name and Strength		Code		Quantity
	1.
	2.
	3.
	4.
	5.
	6.
	7.
	8.
	9.
	10.

PATIENT CARE FORM

Location: ________________________________________

Investigator: ____________________ Date: ____________

Seq. #	Patient Identifier (if needed)	Consulting Time (mins)	Dispensing Time (secs)	# Drugs Prescribed	# Drugs Dispensed	# Adequately Labelled	Knows Dosage (0/1)^*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Count
Total
Average
Percentage					% of prescribed	% of dispensed	% of cases asked

* 0 = No 1 = Yes

FACILITY SUMMARY FORM

Location: ________________________________________

Investigator: ____________________ Date: ____________

Contacts:	_______________________________________________________________
	_______________________________________________________________
Problems or	_______________________________________________________________
Comments:	_______________________________________________________________
	_______________________________________________________________
	_______________________________________________________________
	_______________________________________________________________
# Cases:	Retrospective	__________	covering dates __________		to __________
	Prospective	__________	covering dates __________		to __________
	Patient Care	__________	covering dates __________		to __________
Essential Drug List/Formulary available at facility? (0/1) ________
Key Drugs in Stock to Treat Important Conditions				In Stock (0/1)
_______________________________________				______________	% in stock
_______________________________________				______________	this facility
_______________________________________				______________	%
_______________________________________				______________
_______________________________________				______________
_______________________________________				______________
_______________________________________				______________
_______________________________________				______________
_______________________________________				______________
_______________________________________				______________
_______________________________________				______________
_______________________________________				______________
_______________________________________				______________
_______________________________________				______________

FACILITY INDICATOR REPORTING FORM

Location: ________________________________________

Investigator: ____________________ Date: ____________

		This Facility	National Standard
Number of Cases	Prescribing
	Patient Care

Average number of drugs prescribed
Percentage of drugs prescribed by generic names		%	%
Percentage of encounters with an antibiotic prescribed		%	%
Percentage of encounters with an injection prescribed		%	%
Percentage of drugs prescribed on Essential Drug List		%	%
Average consultation time		mins	mins
Average dispensing time		secs	secs
Percentage of drugs actually dispensed		%	%
Percentage of drugs adequately labelled		%	%
Percent correct patient knowledge of dosage		%	%
Availability of Essential Drugs List or formulary		Yes / No	%
Percentage availability of key indicator drugs		%	%

COMMENTS:

SIGNATURES:

DRUG USE INDICATORS CONSOLIDATION FORM

Location: _________________________ Date: ____________

Date

Facility

Avg. drugs prescribed

Percent generics

Percent antibiotics

Percent injections

Percent on EDL

Consult time

Dispense time

% Drugs Dispensed

% Adequate knowledge

% Drugs in stock

Impartial information

Mean

Maximum

Minimum