Design of a 'day 3 bundle' to improve the reassessment of inpatient empirical antibiotic prescriptions

Celine Pulcini, Sylviane Defres, Ila Aggarwal, Dilip Nathwani, Peter Davey

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    43 Citations (Scopus)

    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 languageEnglish
    Pages (from-to)1384-1388
    Number of pages5
    JournalJournal of Antimicrobial Chemotherapy
    Volume61
    Issue number6
    DOIs
    Publication statusPublished - 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

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