Assessment of Quality Indicators for Appropriate Antibiotic Use

ABSTRACT One of the critical elements of antimicrobial stewardship programs is the ability to measure the quality of antibiotic prescriptions. The aims of the present study were to evaluate the performance properties of a set of previously developed quality indicators (QIs) and to identify the potential room for improvement in antibiotic use in our setting. A monthly cross-sectional point prevalence survey was conducted in a 400-bed acute care teaching hospital, from June to November 2015. All adult patients treated for ≥24 hours with antibiotic therapy for a suspected hospital- or community-acquired bacterial infection were included. Performance scores (adherence, room for improvement, interobserver reliability, and applicability) were calculated for 8 QIs. A total of 362 patients were evaluated. Adherence to the whole set of QIs was accomplished for 14.1% of evaluable patients. The QIs with greater room for improvement were adequate request for blood cultures (60.6%), therapeutic drug monitoring (TDM) (59.1%), sequential antibiotic therapy within 72 hours (48.2%), and empirical antibiotic therapy according to local guidelines (30.4%). The percentage of patients receiving unnecessary antibiotic treatment in the absence of clinical or microbiological evidence of infection after 5 days was 12.2%. All indicators scored kappa values of ≥0.6, suggesting good interobserver reliability. Low applicability (6.1% of reviewed patients) was found only for the TDM QI. The QIs analyzed were found to be applicable, showed good interobserver reliability, and were useful tools to identify areas with potential room for improvement in antibiotic use.

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A prospective antibiotic point prevalence survey in two primary referral hospitals during and after pilgrims stay in Madinah, Saudi Arabia

Tropical Journal of Pharmaceutical Research ◽

10.4314/tjpr.v19i2.23 ◽

2020 ◽

Vol 19 (2) ◽

pp. 391-399

Author(s):

Yaser M. ◽

Ahmad K. Aljabri ◽

Faisal N. Alsaadi ◽

Lamiaa M. Rizk ◽

Renad Y. Alahmadi ◽

...

Keyword(s):

Quality Improvement ◽

Antibiotic Therapy ◽

Prevalence Rate ◽

Antibiotic Use ◽

Point Prevalence ◽

Antibiotic Prescribing ◽

Prevalence Survey ◽

Point Prevalence Survey ◽

Significant Difference ◽

Referral Hospitals

Purpose: To assess current patterns of antibiotic use by carrying out two point-prevalence surveys (PPS) in Madinah after the return of hajj pilgrims from Makkah and when Madinah is free from pilgrims. Methods: In September 2016 and November 2016, a prospective PPS was conducted on two separate dates (during the hajj pilgrims stay in Madinah and after they leave). Data on antibiotics use were generated during these two periods. This involved an audit from all the departments of two referral hospitals (King Fahad Hospital (KFH) - 425 beds, and Al Ansar Hospital - 100 beds) of inpatients records. Data were collected using standard forms adapted from the European Centre for Disease Control (ECDC). Results: A total of 675 inpatients were included in PPS; among them, 332 (49.18 %) patients were receiving antibiotic therapy. In September 2016, 168 patients were treated with antibiotics, with a prevalence rate of 50.60 %, whereas, in November 2016, the prevalence rate was 49.40 %. Overall, 198 patients were identified in surgical wards, of which 132 patients (66.6 %) were receiving antibiotic therapy; 121 patients in ICU of which 70 patients (57.8 %) received antibiotics; 13 patients in other wards of which 6 (46.1 %) received antibiotic treatment; and 343 patients in medical wards of which 126 patients (36.7 %) were treated with antibiotics. There was no significant difference in prevalence of antibiotic prescribing between the two surveys (Pearson Chi-square test, p = 0.56) and with regards to patient age between the two surveys (Mann-Whitney U-test, p = 0.32). Conclusion: The results demonstrate that antibiotic use with adherence to hospital guidelines and PPS helps in identifying targets for quality improvement. Moreover, to escalate the prudent use of antibiotics in hospitals, PPS provides a useful tool. Furthermore, this survey provides a background to evaluate antibiotic use by a standardized methodology. Keywords: Point prevalence survey, Antibiotic use, Prescribing practices, Antibiotic resistance, Quality improvement, Antibiotic stewardship, Hajj, Pilgrims

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EVALUASI KUALITATIF PENGGUNAAN ANTIBIOTIK PADA PASIEN PNEUMONIA RS “X’’ DI MALANG

KELUWIH: Jurnal Kesehatan dan Kedokteran ◽

10.24123/kesdok.v3i1.2887 ◽

2021 ◽

Vol 3 (1) ◽

pp. 9-21

Author(s):

Wirda Anggraini

Keyword(s):

Antibiotic Resistance ◽

Antibiotic Therapy ◽

Medical Record ◽

Antibiotic Use ◽

Observational Method ◽

Negative Effects ◽

Cross Sectional ◽

Cross Sectional Design

Abstract—Pneumonia was an inflammation that occurs in the lungs accompanied by exudation and consolidation of microorganisms. In Indonesia, the prevalence of pneumonia continues to increase. Treatment of pneumonia uses antibiotic therapy. The use of antibiotics needs to be controlled by evaluating the quality of antibiotic use to prevent negative effects that can occur on patients, such as antibiotic resistance. The purpose of this study was to determine the quality of antibiotic use in pneumonia patients. This study did with observational method with cross-sectional design. The study was conducted in August-September 2019. Qualitative evaluations did with Gyssen method. The results of 35 medical record samples that fulfill the criteria showed that 21.43% of cases category 0; 16.67% of cases category I; 0% of cases category II C; 33.34% of cases in category II B; 4.76% of cases category II A; 0% of cases category III B; 0% of cases category III A; 0% of cases category IV D; 19.05% of cases category IV C; 4.76% of cases category IV B; 61.90% of cases category IV A; 0% of cases category V; 0% of cases category VI. Thus, rational cases (category I) were 21,43% and irrational cases (categories I-IV) were 78,57%.

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Quality of documentation on antibiotic therapy in medical records: evaluation of combined interventions in a teaching hospital by repeated point prevalence survey

European Journal of Clinical Microbiology & Infectious Diseases ◽

10.1007/s10096-016-2690-0 ◽

2016 ◽

Vol 35 (9) ◽

pp. 1495-1500 ◽

Cited By ~ 5

Author(s):

C. Vercheval ◽

M. Gillet ◽

N. Maes ◽

A. Albert ◽

F. Frippiat ◽

...

Keyword(s):

Antibiotic Therapy ◽

Teaching Hospital ◽

Medical Records ◽

Point Prevalence ◽

Prevalence Survey ◽

Point Prevalence Survey ◽

Combined Interventions

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Applicability of Quality Indicators for Appropriate Antibiotic use in Outpatient Parenteral Antimicrobial Therapy (OPAT): A Point Prevalence Survey

Frontiers in Pharmacology ◽

10.3389/fphar.2021.713882 ◽

2021 ◽

Vol 12 ◽

Author(s):

Pablo March-López ◽

Inés Arancibia Freixa ◽

Mireia Martinez Gil ◽

Gastón Araujo Espinoza ◽

Lidia Ortega Polonio ◽

...

Keyword(s):

Quality Indicators ◽

Antimicrobial Therapy ◽

Treatment Plan ◽

Antibiotic Use ◽

Critical Element ◽

Dose Frequency ◽

Prevalence Survey ◽

Outpatient Parenteral Antimicrobial Therapy ◽

Quantitative Indicators

The ability to measure the quality of antibiotic prescription is a critical element in any antimicrobial stewardship programme. The aim of this study was to evaluate the clinimetric properties of 33 quality indicators (QIs) developed to assess Outpatient Parenteral Antimicrobial Therapy (OPAT) and to identify potential room for improvement in a hospital-at-home (HaH) unit. Study performed in a healthcare district in Barcelona, Spain with 260,657 inhabitants, nine primary healthcare centres, a 400-bed acute care teaching hospital, and an HaH unit. We studied 33 QIs on appropriate antibiotic use and classified them as qualitative or quantitative. Quantitative QIs were further categorized as measurable or non-measurable depending on the availability of data in the patients’ medical records. Data from 202 OPAT episodes in 192 patients were assessed. Adherence was found for 22 of the 24 qualitative QIs analyzed; the other two showed room for improvement. Four of the nine quantitative indicators were non-measurable. High adherence rates were achieved for QI-17 “The OPAT plan should be documented” (84.65%), QI-26 “The OPAT treatment plan should include choice, dose, frequency, duration and follow-up plan” (79.70%), and QI-33 “The team should document clinical response” (94.55%). Adverse events were documented in just 1.98% of cases (QI-32) and 92.57% patients were classified as alive on discharge (QI-24). The QIs evaluated were applicable to clinical practice and proved useful for identifying areas with room for improvement in our setting and for guiding the design of future interventions with specific objectives.

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A point prevalence survey of antibiotic use in four acute-care teaching hospitals utilizing the European Surveillance of Antimicrobial Consumption (ESAC) audit tool

Epidemiology and Infection ◽

10.1017/s095026881100241x ◽

2011 ◽

Vol 140 (9) ◽

pp. 1714-1720 ◽

Cited By ~ 11

Author(s):

M. A. ALDEYAB ◽

M. P. KEARNEY ◽

J. C. McELNAY ◽

F. A. MAGEE ◽

G. CONLON ◽

...

Keyword(s):

Quality Improvement ◽

Prophylactic Antibiotic ◽

Antibiotic Use ◽

Point Prevalence ◽

Teaching Hospitals ◽

Antibiotic Prescribing ◽

Prevalence Survey ◽

Point Prevalence Survey ◽

Indication For Treatment

SUMMARYThe objective of this research was to assess current patterns of hospital antibiotic prescribing in Northern Ireland and to determine targets for improving the quality of antibiotic prescribing. A point prevalence survey was conducted in four acute teaching hospitals. The most commonly used antibiotics were combinations of penicillins including β-lactamase inhibitors (33·6%), metronidazole (9·1%), and macrolides (8·1%). The indication for treatment was recorded in 84·3% of the prescribing episodes. A small fraction (3·9%) of the surgical prophylactic antibiotic prescriptions was for >24 h. The results showed that overall 52·4% of the prescribed antibiotics were in compliance with the hospital antibiotic guidelines. The findings identified the following indicators as targets for quality improvement: indication recorded in patient notes, the duration of surgical prophylaxis and compliance with hospital antibiotic guidelines. The results strongly suggest that antibiotic use could be improved by taking steps to address the identified targets for quality improvement.

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Development of key quality indicators for appropriate antibiotic use in the Republic of Korea: results of a modified Delphi survey

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-021-00913-y ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Bongyoung Kim ◽

◽

Myung Jin Lee ◽

Se Yoon Park ◽

Song Mi Moon ◽

...

Keyword(s):

Antibiotic Therapy ◽

Quality Indicators ◽

Antibiotic Stewardship ◽

Antibiotic Use ◽

Republic Of Korea ◽

Cochrane Library ◽

Surgical Prophylaxis ◽

Modified Delphi ◽

Stewardship Program ◽

The Republic

Abstract Background An effective antibiotic stewardship program relies on the measurement of appropriate antibiotic use, on which there is a lack of consensus. We aimed to develop a set of key quality indicators (QIs) for nationwide point surveillance in the Republic of Korea. Methods A systematic literature search of PubMed, EMBASE, and Cochrane Library (publications until 20th November 2019) was conducted. Potential key QIs were retrieved from the search and then evaluated by a multidisciplinary expert panel using a RAND-modified Delphi procedure comprising two online surveys and a face-to-face meeting. Results The 23 potential key QIs identified from 21 studies were submitted to 25 multidisciplinary expert panels, and 17 key QIs were retained, with a high level of agreement (13 QIs for inpatients, 7 for outpatients, and 3 for surgical prophylaxis). After adding up the importance score and applicability, six key QIs [6 QIs (Q 1–6) for inpatients and 3 (Q 1, 2, and 5) for outpatients] were selected. (1) Prescribe empirical antibiotic therapy according to guideline, (2) change empirical antibiotics to pathogen-directed therapy, (3) obtain culture samples from suspected infection sites, (4) obtain two blood cultures, (5) adapt antibiotic dosage to renal function, and (6) document antibiotic plan. In surgical prophylaxis, the QIs to prescribe antibiotics according to the guideline and initiate antibiotic therapy 1 h before incision were selected. Conclusions We identified key QIs to measure the appropriateness of antibiotic therapy to identify targets for improvement and to evaluate the effects of antibiotic stewardship intervention.

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Effects of coronavirus disease 2019 (COVID-19) pandemic on antimicrobial prevalence and prescribing in a tertiary hospital in Singapore

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-021-00898-8 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Tat Ming Ng ◽

Sock Hoon Tan ◽

Shi Thong Heng ◽

Hui Lin Tay ◽

Min Yi Yap ◽

...

Keyword(s):

Infectious Disease ◽

Quality Indicators ◽

Survey Methodology ◽

Tertiary Hospital ◽

Full Time ◽

Full Time Equivalent ◽

Prevalence Survey ◽

Antimicrobial Prescribing ◽

Point Prevalence Survey ◽

Prescribing Quality

Abstract Background The deployment of antimicrobial stewardship (AMS) teams to deal with the COVID-19 pandemic can lead to a loss of developed frameworks, best practices and leadership resulting in adverse impact on antimicrobial prescribing and resistance. We aim to investigate effects of reduction in AMS resources during the COVID-19 pandemic on antimicrobial prescribing. Methods One of 5 full-time equivalent AMS pharmacists was deployed to support pandemic work and AMS rounds with infectious disease physicians were reduced from 5 to 2 times a week. A survey in acute inpatients was conducted using the Global Point Prevalence Survey methodology in July 2020 and compared with those in 2015 and 2017–2019. Results The prevalence of antimicrobial prescribing (55% in 2015 to 49% in 2019 and 47% in 2020, p = 0.02) and antibacterials (54% in 2015 to 45% in 2019 and 42% in 2020, p < 0.01) have been reducing despite the pandemic. Antimicrobial prescribing in infectious disease wards with suspected or confirmed COVID-19 cases was 29% in 2020. Overall, antimicrobial prescribing quality indicators continued to improve (e.g. reasons in notes, 91% in 2015 to 94% in 2019 and 97% in 2020, p < 0.01) or remained stable (compliance to guideline, 71% in 2015 to 62% in 2019 and 73% in 2020, p = 0.08). Conclusion During the COVID-19 pandemic, there was no increase in antimicrobial prescribing and no significant differences in antimicrobial prescribing quality indicators.

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Correlation of Knowledge and Beliefs to Adherence with Antibiotic Use in Adult Patients at a Private Hospital in Sidoarjo

Kesmas National Public Health Journal ◽

10.21109/kesmas.v15i2.2409 ◽

2020 ◽

Vol 15 (2) ◽

Author(s):

Muhammad Hasan Wattiheluw ◽

Fauna Herawati ◽

Setiasih Setiasih ◽

Rika Yulia

Keyword(s):

Infectious Diseases ◽

Antibiotic Therapy ◽

Private Hospital ◽

Antibiotic Use ◽

Cross Sectional Study ◽

P Value ◽

Cross Sectional ◽

Knowledge And Beliefs ◽

Study Results ◽

Hospitalization Period

Infectious diseases are one of the top ten causes of death in the world. Antibiotic therapy is administered for infectious diseases, but if bacteria are exposed to antibiotics continuously, then the bacteria are able to adapt to the medication, thereby resulting in antibiotic resistance. This condition results in an increase in mortality, long hospitalization period, and increased cost of antibiotic therapy and health services. Adherence to using antibiotics may be influenced by knowledge and beliefs about them. This study aimed to understand correlation between knowledge and belief with adherence to antibiotic use at a private hospital in Sidoarjo. This cross-sectional study, the data collected in three months period, was conducted with a questionnaire for assessment knowledge and belief. A pill count method was applied for assessment adherence to using antibiotics prescribed by doctors. The study results show that knowledge of the respondents was adequate for 76 people (69.7%), belief was adequate for 74 people (67.9%), and adherence to antibiotic use for 79 people (72%). Regression analysis showed that the variable that significantly influenced the adherence of patients in using antibiotics was perceived threat (p-value = 0,029). Sex, age, education, income, occupation, and marital status have no contribution to antibiotic knowledge, belief, and adherence.

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