Background
Methods
Setting & study population
Hospital and A-team characteristics
Monitoring, documenting and reporting recommended antimicrobial use: Stewardship objectives and QIs
Number | Stewardship objective, process of care recommendation | Corresponding quality indicator | |
---|---|---|---|
Numerator description | Denominator description | ||
1 | Take 2 sets of blood cultures before starting antibiotic therapy | Number of patients in whom at least 2 sets of blood cultures were taken before systemic antibiotic therapy was started | Total number of patients who started with empirical systemic antibiotic therapy |
2 | Take cultures from suspected sites of infection | Number of patients in whom cultures from suspected sites of infections were taken within 24 h after the systemic antibiotics were started | Total number of patients who started with systemic antibiotic therapy |
3 | Prescribe empirical antibiotic therapy according to local guidelinea
| Number of patients who started with empirical systemic antibiotic therapy according to the national guideline | Total number of patients who started with empirical systemic antibiotic therapy |
4 | Adapt antibiotic dosage to renal function | Number of patients with a compromised renal function with a dosing regimen adjusted to renal function | Total number of patients who started with systemic antibiotic therapy which should be dosed according to renal function, and who had an unknown or compromised renal function. |
5 | Document antibiotic plan | Number of patients for whom an antibiotic plan was documented in the case notes | Total number of patients who started with systemic antibiotic therapy |
6 | Change empirical to pathogen-directed therapy | Number of patients with empirical therapy whose culture became positive and changing to pathogen-directed therapy was done correctly. | Total number of patients with empirical systemic antibiotics, whose culture became positive |
7 | Switch from intravenous to oral therapy on the basis of the clinical condition and when oral treatment is adequate | Number of patients with intravenous antibiotics for 48-72 h, in whom changing to oral antibiotic therapy on the basis of clinical conditions was done. | Total number of patients with intravenous antibiotics for 48-72 h, in whom changing to oral antibiotic therapy on the basis of the clinical condition was indicated |
8 | Perform therapeutic drug monitoring when the therapy is >3 days for aminoglycosides and >5 days for vancomycin | Number of patients on aminoglycosides or vancomycine in whom a serum drug level has been determined after respectively >3 or >5 days of therapy | Total number of patients who received aminoglycosides for >3 days and/or vancomycin for >5 days |
9 | Discontinue antibiotic therapy if infection is not confirmed | Number of patients whose empirical antibiotic therapy was discontinued within 7 days based on the lack of clinical and/or microbiological evidence of infection. | Total number of patients who started empirical systemic antibiotic therapy, but lacked clinical and/or microbiological evidence of infection. |
10 | Perform ID specialist bedside consultations in hospitalized patients with a Staphylococcus aureus bacteremia | Number of patients with Staphylococcus aureus bacteremia who had a bedside consultation of an ID specialist | Total number of patient with a Staphylococcus aureus bacteremia |
11 | Assess patients’ adherence | Number of patients adherent to the prescription’s instructions | Total number of patients with a prescription of antibiotics |
Stewardship objective, organization of care recommendation | |||
12 | A local antibiotic guideline should be present and an update should be done every 3 years | ||
13 | The local guidelines should correspond to the national antibiotic guidelines but deviate based on local resistance patterns | ||
14 | A list of restricted antibiotics should be present |
Monitoring: a local member of the A-team assesses empirically prescribed restricted antibiotics for accordance with the local guideline, using daily generated lists (Stewardship objective 3, Table 1
).
|
Documentation: The A-team member documents both the appropriate and inappropriate prescriptions, including the prescribing department. |
Reporting: Each department receives an annual report about the quality of empirical use of restricted antibiotics. Quality indicator performance is presented as the percentage of appropriate prescriptions. |
Results
Hospital and A-team characteristics
Hospital | A | B | C | D | E | |
---|---|---|---|---|---|---|
Number of hospital beds | 1002 | 953 | 268 | 554 | 543 | |
A-team composition | Hospital pharmacist | + | + | + | + | + |
ID specialist | + | + | + | + | + | |
Microbiologist | + | + | + | + | + | |
Information technician | − | − | − | − | + | |
Nurse | − | − | + | − | − | |
Quality of care specialist | − | + | − | − | − | |
Year of establishment of A-team | 2014 | 2015 | 2013 | 2014 | 2014 | |
Total numbers of prescriptions documented | 343 | 1824 | 1729 | 575 | 436 | |
Electronic Medical Record Present | − | + | − | − | +a
| |
Electronic Prescribing System Present | + | + | + | + | + |
Monitoring and documentation
Hospital | |||||||
---|---|---|---|---|---|---|---|
Process of care recommendation | Activity | A | B | C | D | E | Total |
Blood cultures taken? | Monitored | − | − | − | + | − | 1/5 (20%) |
Documented | − | − | − | + | − | 1/5 (20%) | |
Reported | − | − | − | + | − | 1/5 (20%) | |
Antibiotics prescribed according to local guideline? | Monitored | + | + | + | + | + | 5/5 (100%) |
Documented | + | + | + | + | + | 4/5 (80%) | |
Reported | + | + | + | + | -*
| 1/5 (20%) | |
Therapy switched from intravenous to oral therapy? | Monitored | − | + | + | − | + | 3/5 (60%) |
Documented | − | + | + | − | − | 2/5 (40%) | |
Reported | − | + | -*
| − | − | 1/5 (20%) | |
Therapeutic drug monitoring performed? | Monitored | − | + | + | + | + | 4/5 (80%) |
Documented | − | + | − | − | − | 1/5 (20%) | |
Reported | − | + | − | − | − | 1/5 (20%) | |
Bedside consultation performed for S.aureus bacteremia? | Monitored | + | + | + | + | + | 5/5 (100%) |
Documented | − | + | − | − | − | 1/5 (20%) | |
Reported | − | + | − | − | − | 1/5 (20%) | |
Organization of care recommendation
| |||||||
Local antibiotic guideline is present | + | + | + | + | + | 5/5 (100%) | |
Local guideline corresponds to national guideline | + | + | + | + | + | 5/5 (100%) | |
List of restricted antibiotics is present | + | + | + | + | + | 5/5 (100%) |