Abstract
Objectives: To develop and test a set of process measures of quality of care in the reassessment of inpatient empirical antibiotic prescriptions, to determine the inter-rater reliability of medical notes' review in assessment of these measures and to test these measures on one ward.
Methods: Measures of process of care were identified from a literature review. Forty sets of medical notes were reviewed by two independent doctors and the inter-rater reliability determined using observed percentage agreement and the kappa statistic. These measures were collected weekly and fed back to doctors in order to stimulate improvement.
Results: Four process measures were identified and were grouped together to create a 'day 3 bundle': antibiotic plan, review of the diagnosis, adaptation to microbiology and intravenous-oral switch. The inter-rater agreement was >= 80% for all measures. Data collection was feasible and was easily sustained over several weeks. The reassessment of antibiotic prescriptions around day 3 was better documented using real-time feedback of the measures to the medical team.
Conclusions: Our measures of care are suitable for the reassessment of empirical inpatient antibiotic prescriptions, with good inter-rater reliability. This quality intervention should be part of a more comprehensive and multifaceted plan to improve antibiotic use in hospitals.
| Original language | English |
|---|---|
| Pages (from-to) | 1384-1388 |
| Number of pages | 5 |
| Journal | Journal of Antimicrobial Chemotherapy |
| Volume | 61 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - Jun 2008 |
Keywords
- indicator
- quality assurance
- switch therapy
- antibiotic therapy
- medical decision-making
- prescribing practice
- hospital infections
- ANTIMICROBIAL RESISTANCE
- QUALITY IMPROVEMENT
- EXPLICIT INDICATORS
- INTERVENTION
- RELIABILITY
- HOSPITALS
- CARE
- APPROPRIATENESS
- TRIAL
- INFECTIONS