Before initiating use of antibiotics, it is important to pause and review all relevant clinical and laboratory data and then weigh the potential benefit versus harm of initiating antibiotic therapy. The Agency for Healthcare Research and Quality’s (AHRQ’s) Four Moments of Antibiotic Decision Making are the critical time periods of antibiotic decision making. Clinicians are encouraged to use the Four Moments framework for all patients receiving antibiotics and whenever the need for antibiotics is being considered.
The Four Moments includes:
- Moment One: Does my patient have an infection that requires an antibiotic?
- Moment Two: Have I ordered appropriate cultures before starting antibiotics? What empiric therapy should I initiate?
- Moment Three: A day or more has passed, can I stop antibiotics? Can I narrow therapy or change from IV to oral therapy? Those questions should be asked every day a patient is on an antibiotic.
- Moment Four: What duration of antibiotic therapy is needed for my patient’s diagnosis?
Several actions can be taken to integrate the Four Moments into regular practice. Local guidelines should be developed using the Four Moments framework. All “Best Practices” presentations in the AHRQ Safety Program Toolkit incorporate the Four Moments framework and most have One Page Document templates to assist with guideline development.
Resources to help integrate the Four Moments into regular practice, include:
- The Four Moments of Antibiotic Decision Making Posters and Screen Saver
- Antibiotic Time Out Tool
- Team Antibiotic Review Form
Medication errors, drug reactions, overdoses and allergic reactions are all types of Adverse Drug Events (ADEs). Fortunately, many ADEs are preventable, can impact positive health outcomes and decrease healthcare costs. Improving antibiotic use should be viewed as a patient safety issue. Clinicians involved in antibiotic prescribing should be encouraged to understand both the benefits and risks of antibiotic use and be engaged in reducing harm, which often requires a change in thinking and behavior. The Great Plains QIN team works to support existing state-based and community-based efforts and coalitions in the Dakotas to improve care and offers guidance, expertise and resources to help streamline efforts, reduce duplication, connect leaders and improve the quality of care in our communities, including medication safety. Visit the Quality Care Coalition page to learn more.