An Assessment of a Prototype Audit and Feedback Process to Improve Inpatient Pain Documentation

2014 ◽  
Author(s):  
Matthew Peters
Keyword(s):  
Audit And Feedback ◽  
Feedback Process ◽  
Pain Documentation

scholarly journals Audit and Feedback in emergency: a systematic review and an Italian project to investigate and improve quality of care

2020 ◽  
Vol 16 (3) ◽  
Author(s):  
Sabrina Licata ◽  
Annarita Tullio ◽  
Francesca Valent
Keyword(s):  
Systematic Review ◽  
Audit And Feedback ◽  
Clinical Settings ◽  
Improve Quality ◽  
Multimodal Approach ◽  
Review Of Literature ◽  
Feedback Process ◽  
Wide Range ◽  
The Impact

The Audit and Feedback process (A&F) is commonly accepted as a good way to improve quality in health care, also in Emergency Departments (ED), where health aspects and pathologies are very different, usually acute and highly complex. Within an Italian Ministry of Health research project called EASY-NET, we conducted a systematic review of literature on A&F in EDs from 2014 to December 2019 to evaluate the impact of this approach in a particular setting where time-dependent indicators are fundamental. We selected 24 articles: 9 about infective pathologies (i.e. antibiotic stewardship), 6 about cardiovascular acute emergencies (i.e. cardiac arrest), 2 about stroke, 3 about laboratory tests, and 4 about other fields (i.e. diabetic ketoacidosis or use of prothrombin complex). Most of articles proposed a multimodal approach: only 7 concerned A&F alone. Despite the wide range on interventions modality and the poor comparability of the considered studies, the results are encouraging and confirm the importance to implement A&F both in emergency and in other clinical settings.

Impact of pharmacist-led selective audit and feedback on outpatient antibiotic prescribing for UTIs and SSTIs

2021 ◽  
Author(s):  
Patricia W Choi ◽  
Jessica A Benzer ◽  
Joel Coon ◽  
Nnaemeka E Egwuatu ◽  
Lisa E Dumkow
Keyword(s):  
Primary Care ◽  
The United States ◽  
Empiric Therapy ◽  
Primary Objective ◽  
Audit And Feedback ◽  
Antibiotic Prescribing ◽  
Feedback Process ◽  
Clostridioides Difficile ◽  
The Individual ◽  
Tract Infections

Abstract Purpose An estimated 30% of all outpatient antibiotic prescriptions in the United States are unnecessary. The Joint Commission in 2016 implemented core elements of performance requiring antimicrobial stewardship programs (ASPs) to expand to outpatient practice settings. A study was conducted to determine whether pharmacist-led audit and feedback would improve antibiotic prescribing for urinary tract infections (UTIs) and skin and soft tissue infection (SSTIs) at 2 primary care practices. Methods A retrospective, quasi-experimental study was conducted to evaluate antibiotic prescribing for patients treated for a UTI or SSTI at 2 primary care offices (a family medicine office and an internal medicine office). The primary objective was to compare the rate of appropriate antibiotic prescribing to patients treated before implementation of a pharmacist-led audit-and-feedback process for reviewing antibiotics prescribed for UTIs and SSTIs (the pre-ASP group) and patients treated after process implementation (the post-ASP group). Total regimen appropriateness was defined by appropriate antibiotic selection, dose, duration, and therapy indication in accordance with institutional outpatient empiric therapy guidelines. Secondary objectives included comparing rates of infection-related revisits and Clostridioides difficile infection between groups. Results A total of 400 patients were included in the study (pre-ASP gropu, n = 200; post-ASP group, n = 200). The rate of total antibiotic prescribing appropriateness improved significantly, from 27.5% to 50.5% (P < 0.0001), after implementation of the audit-and-feedback process. There were also significant improvements in the post-ASP group vs the pre-ASP period in the individual components of regimen appropriateness: appropriate drug (70% vs 53%, P < 0.001), appropriate duration (83.5% vs 57.5% , P < 0.001), and appropriate therapy indication (98% vs 94% , P = 0.041). There were no significant between-group differences in other outcomes such as rates of adverse events, treatment failure, C. difficile infection, and infection-related revisits or hospitalizations within 30 days. Conclusion A pharmacist-led audit-and-feedback outpatient stewardship strategy was demonstrated to achieve significant improvement in outpatient antibiotic prescribing for UTI and SSTI.

scholarly journals 140. Impact of Pharmacist-led Audit & Feedback on Outpatient Antibiotic Prescribing for UTIs and SSTIs

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S81-S81
Author(s):  
Patricia Choi ◽  
Jessica Benzer ◽  
Joel Coon ◽  
Nnaemeka Egwuatu ◽  
Lisa E Dumkow
Keyword(s):  
Primary Care ◽  
Patient Outcomes ◽  
Adverse Drug Events ◽  
Empiric Therapy ◽  
Primary Objective ◽  
Audit And Feedback ◽  
Antibiotic Prescribing ◽  
Feedback Process ◽  
Clostridioides Difficile ◽  
Tract Infections

Abstract Background An estimated 30% of all outpatient antibiotic prescriptions in the U.S. are unnecessary. Effective January 2020, The Joint Commission has implemented new core elements of performance requiring antimicrobial stewardship programs (ASP) to expand to outpatient practice settings. The purpose of this study was to determine whether pharmacist-led audit-and-feedback would improve antibiotic prescribing for urinary tract infections (UTI) and skin and soft tissue infection (SSTI) at two primary care practices. Methods This retrospective, quasi-experimental study was conducted evaluating patients treated for UTI and SSTI at two outpatient primary care offices, one Family Medicine and the other Internal Medicine. The primary objective was to compare rates of total appropriateness of antibiotic prescribing before (Pre-ASP) versus after (Post-ASP) implementing a pharmacist-led audit-and-feedback process reviewing antibiotics prescribed for UTIs and SSTIs. Total appropriateness was defined by appropriate antibiotic selection, dose, duration, and therapy indication in accordance with institutional outpatient empiric therapy antimicrobial guidelines. Secondary objectives included comparing patient outcomes, including infection-related re-visits and Clostridioides difficile infections between groups. Results A total of 400 patients were included in this study (Pre-ASP n=200, Post-ASP n=200) Total antibiotic appropriateness improved significantly from 27.5% to 50.5% after implementation of the audit-and-feedback process (p< 0.0001). Significant improvement was also seen for individual prescribing components including appropriate drug selection (94% vs. 98%, p=0.041), duration (57.5% vs.83.5%, p< 0.0001), and therapy indication (94% vs. 98%, p=0.041). There were no differences in patient outcomes between groups including adverse drug events, treatment failure, C.difficile infections, and infection-related re-visits or hospitalizations within 30 days. Conclusion A pharmacist-led audit-and-feedback outpatient stewardship strategy demonstrated significant improvement in outpatient antibiotic prescribing for UTI and SSTI. Disclosures All Authors: No reported disclosures

Improving English L2 Writing in Web Communication: Can Peer Feedback Help?

Fachsprache ◽  
2018 ◽  
Vol 40 (3-4) ◽  
pp. 94-121
Author(s):  
Marian Flanagan ◽  
Carmen Heine
Keyword(s):  
Higher Education ◽  
English Language ◽  
Language Skills ◽  
Peer Feedback ◽  
Status Quo ◽  
Teacher Feedback ◽  
Written Feedback ◽  
Feedback Process ◽  
English Writing ◽  
Web Communication

As teachers of English as a second language (L2) in web communication, our aim is to help L2 students improve their spoken and written English language skills. Teacher feedback has been shown to do this in some cases. However, only using teacher feedback can put huge pressure on the teacher, both in terms of time and resources. This paper describes and discusses our attempt at introducing peer feedback as an additional way of providing students with feedback on their English writing. Before conducting this study, we did not know if peer feedback would be feasible in our teaching environment or whether it would benefit the students and teachers. Our aim was to establish a status quo of our students’ abilities in providing and implementing peer feedback. We introduced peer-feedback tasks and focused on the types of feedback provided by the students, the phrasing of the feedback, both when implemented and not implemented by the students, and the types of revisions made by the students. Our findings allowed us to develop peer-feedback process guidelines for web communication as a way towards improving written feedback processes in higher education, and hopefully for others to adapt and implement in their own communication classrooms.

Retrospective analysis of mortality within 30 days of systemic anticancer therapy and comparison with a previous audit at an Australian Regional Cancer Centre

2021 ◽  
pp. 107815522110160
Author(s):  
Bernadatte Zimbwa ◽  
Peter J Gilbar ◽  
Mark R Davis ◽  
Srinivas Kondalsamy-Chennakesavan
Keyword(s):  
Checkpoint Inhibitors ◽  
Anticancer Therapy ◽  
Mortality Rates ◽  
Feedback Process ◽  
Time To Death ◽  
Cancer Centre ◽  
Haematology Patients ◽  
The Mean ◽  
Regional Cancer Centre ◽  
Mean Time

Purpose To retrospectively determine the rate of death occurring within 14 and 30 days of systemic anticancer therapy (SACT), compare this against a previous audit and benchmark results against other cancer centres. Secondly, to determine if the introduction of immune checkpoint inhibitors (ICI), not available at the time of the initial audit, impacted mortality rates. Method All adult solid tumour and haematology patients receiving SACT at an Australian Regional Cancer Centre (RCC) between January 2016 and July 2020 were included. Results Over a 55-month period, 1709 patients received SACT. Patients dying within 14 and 30 days of SACT were 3.3% and 7.0% respectively and is slightly higher than our previous study which was 1.89% and 5.6%. Mean time to death was 15.5 days. Males accounted for 63.9% of patients and the mean age was 66.8 years. 46.2% of the 119 patients dying in the 30 days post SACT started a new line of treatment during that time. Of 98 patients receiving ICI, 22.5% died within 30 days of commencement. Disease progression was the most common cause of death (79%). The most common place of death was the RCC (38.7%). Conclusion The rate of death observed in our re-audit compares favourably with our previous audit and is still at the lower end of that seen in published studies in Australia and internationally. Cases of patients dying within 30 days of SACT should be regularly reviewed to maintain awareness of this benchmark of quality assurance and provide a feedback process for clinicians.

scholarly journals Accuracy of emergency physicians’ self-estimates of CT scan utilization and its potential effect on an audit and feedback intervention: a randomized trial

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Celine Larkin ◽  
Alexandra M. Sanseverino ◽  
James Joseph ◽  
Lauren Eisenhauer ◽  
Martin A. Reznek
Keyword(s):  
Randomized Trial ◽  
Repeated Measures ◽  
Intervention Group ◽  
Potential Effect ◽  
Audit And Feedback ◽  
Emergency Physicians ◽  
Feedback Intervention ◽  
Experimental Conditions ◽  
Actual Performance ◽  
Ct Utilization

Abstract Background Audit and feedback (A&F) has been used as a strategy to modify clinician behavior with moderate success. Although A&F is theorized to work by improving the accuracy of clinicians’ estimates of their own behavior, few interventions have included assessment of clinicians’ estimates at baseline to examine whether they account for intervention success or failure. We tested an A&F intervention to reduce computed tomography (CT) ordering by emergency physicians, while also examining the physicians’ baseline estimates of their own behavior compared to peers. Methods Our study was a prospective, multi-site, 20-month, randomized trial to examine the effect of an A&F intervention on CT ordering rates, overall and by test subtype. From the electronic health record, we obtained 12 months of baseline CT ordering per 100 patients treated for every physician from four emergency departments. Those who were randomized to receive A&F were shown a de-identified graph of the group’s baseline CT utilization, asked to estimate wherein the distribution of their own CT order practices fell, and then shown their actual performance. All participants also received a brief educational intervention. CT ordering rates were collected for all physicians for 6 months after the intervention. Pre-post ordering rates were compared using independent and repeated measures t tests. Results Fifty-one of 52 eligible physicians participated. The mean CT ordering rate increased significantly in both experimental conditions after the intervention (intervention pre = 35.7, post = 40.3, t = 4.13, p < 0.001; control pre = 33.9, post = 38.9, t = 3.94, p = 0.001), with no significant between-group difference observed at follow-up (t = 0.43, p = 0.67). Within the intervention group, physicians had poor accuracy in estimating their own ordering behavior at baseline: most overestimated and all guessed that they were in the upper half of the distribution of their peers. CT ordering increased regardless of self-estimate accuracy. Conclusions Our A&F intervention failed to reduce physician CT ordering: our feedback to the physicians showed most of them that they had overestimated their CT ordering behavior, and they were therefore unlikely to reduce it as a result. After “audit,” it may be prudent to assess baseline clinician awareness of behavior before moving toward a feedback intervention.

scholarly journals Promoting HIV indicator condition-guided testing in hospital settings (PROTEST 2.0): study protocol for a multicentre interventional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Saskia J. Bogers ◽  
Maarten F. Schim van der Loeff ◽  
Udi Davidovich ◽  
Anders Boyd ◽  
Marc van der Valk ◽  
...  
Keyword(s):  
The Netherlands ◽  
Hiv Testing ◽  
Quantitative Methods ◽  
Hospital Setting ◽  
Audit And Feedback ◽  
Interventional Study ◽  
Hiv Diagnosis ◽  
Post Intervention ◽  
Hiv Test ◽  
Undiagnosed Hiv

Abstract Background Late presentation remains a key barrier towards controlling the HIV epidemic. Indicator conditions (ICs) are those that are AIDS-defining, associated with a prevalence of undiagnosed HIV > 0.1%, or whose clinical management would be impeded if an HIV infection were undiagnosed. IC-guided HIV testing is an effective strategy in identifying undiagnosed HIV, but opportunities for earlier HIV diagnosis through IC-guided testing are being missed. We present a protocol for an interventional study to improve awareness of IC-guided testing and increase HIV testing in patients presenting with ICs in a hospital setting. Methods We designed a multicentre interventional study to be implemented at five hospitals in the region of Amsterdam, the Netherlands. Seven ICs were selected for which HIV test ratios (proportion of patients with an IC tested for HIV) will be measured: tuberculosis, cervical/vulvar cancer or high-grade cervical/vulvar dysplasia, malignant lymphoma, hepatitis B and C, and peripheral neuropathy. Prior to the intervention, a baseline assessment of HIV test ratios across ICs will be performed in eligible patients (IC diagnosed January 2015 through May 2020, ≥18 years, not known HIV positive) and an assessment of barriers and facilitators for HIV testing amongst relevant specialties will be conducted using qualitative (interviews) and quantitative methods (questionnaires). The intervention phase will consist of an educational intervention, including presentation of baseline results as competitive graphical audit and feedback combined with discussion on implementation and opportunities for improvement. The effect of the intervention will be assessed by comparing HIV test ratios of the pre-intervention and post-intervention periods. The primary endpoint is the HIV test ratio within ±3 months of IC diagnosis. Secondary endpoints are the HIV test ratio within ±6 months of diagnosis, ratio ever tested for HIV, HIV positivity percentage, proportion of late presenters and proportion with known HIV status prior to initiating treatment for their IC. Discussion This protocol presents a strategy aimed at increasing awareness of the benefits of IC-guided testing and increasing HIV testing in patients presenting with ICs in hospital settings to identify undiagnosed HIV in Amsterdam, the Netherlands. Trial registration Dutch trial registry: NL7521. Registered 14 February 2019.

scholarly journals Increased Return Clinic Visits for Adults with Group A Streptococcal Pharyngitis Treated with a Macrolide

2020 ◽  
Vol 41 (S1) ◽  
pp. s295-s296
Author(s):  
Suzette Rovelsky ◽  
Benjamin Pontefract ◽  
McKenna Nevers ◽  
Adam Hersh ◽  
Matthew Samore ◽  
...  
Keyword(s):  
Index Date ◽  
Penicillin Allergy ◽  
Audit And Feedback ◽  
Urgent Care ◽  
Diagnostic Code ◽  
Feedback Intervention ◽  
Acute Pharyngitis ◽  
Return Visit ◽  
Group A ◽  
Return Visits

Background: A multicenter audit-and-feedback intervention was conducted to improve management of acute respiratory infections (ARIs) including group A streptococcal (GAS) pharyngitis within 6 VA medical Centers (VAMCs). A relative reduction (24.8%) in azithromycin prescribing after the intervention was observed. Within these facilities during 2015–2018, 2,266 cases of GAS occurred, and susceptibility to erythromycin ranged from 55% to 70%. We evaluated whether prescribing a macrolide for GAS pharyngitis was associated with an increase in outpatient return visits. Methods: A cohort of ambulatory adults treated for GAS pharyngitis (years 2014–2019) at 6 VAMCs was created. Demographic, diagnostic, treatment, and revisit data were extracted from the Corporate Data Warehouse. GAS pharyngitis was defined by an acute pharyngitis diagnostic code combined with a GAS-positive rapid strep test or throat culture ≤3 days of index date. Antibiotic prescriptions were included if filled ≤3 days of index date and were classified as first line (penicillin/amoxicillin), second line (cephalexin/clindamycin), macrolides (azithromycin, clarithromycin, erythromycin), or other (remaining antibiotics). A return visit was defined as a new visit to primary care, urgent care, or the emergency department with a diagnostic code for an ARI ≤30 days from the index visit. Logistic regression was used to adjust for nonantibiotic covariates and to compare treatments. Results are reported as odds ratio (OR ± 95% CI; P value). Results: Of 12,666 patients with a diagnostic code for acute pharyngitis, 2,923 (23.1%) had GAS testing performed. Of those, 582 (19.9%) were GAS-positive and 460 (15.7%) received antibiotics. The mean age was 39.0 years (±SD, 11.7) and 73.7% were male. Antibiotics included penicillins for 363 patients (78.9%), cephalosporins for 21 (4.6%), clindamycin for 32 (7.0%), macrolides for 47 (10.2%), and other for 17 (3.9%). Penicillin allergy was documented in 48 patients (10.5%), and these patients received cephalosporins (18.8%), clindamycin (35.4%), macrolides (41.7%), and other antibiotics (4.2%). Return visits occurred in 47 cases (10.4%). Limited chart review indicated that 6 of 10 macrolide recipients (60.0%) with return visits had recurrence or unresolved symptoms. After adjustment for calendar month and facility, odds of a return visit for treatment with a macrolide relative to penicillins was 2.79 (OR, 1.19; 95% CI, ±6.56; P = .02). The audit-feedback intervention was not associated with ARI-related return visits (OR, 0.53; 95% CI, 0.26–1.06; P = .07). Conclusions: Return visit rates were higher for GAS pharyngitis patients treated with a macrolide than for those treated with penicillins. Macrolides were the most commonly prescribed non-penicillin therapy irrespective of penicillin allergy. Further work is necessary to determine the reason for the increase in return visits.Funding: NoneDisclosures: None

scholarly journals Improving intravenous-to-oral antibiotic switch in children: a team-based audit and implementation approach

2021 ◽  
Vol 10 (1) ◽  
pp. e001120
Author(s):  
Brendan Joseph McMullan ◽  
Michelle Mahony ◽  
Lolita Java ◽  
Mona Mostaghim ◽  
Michael Plaister ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Antibiotic Use ◽  
Hospital Length ◽  
Audit And Feedback ◽  
Hospital Length Of Stay ◽  
Oral Antibiotic ◽  
Intravenous Therapy ◽  
Paediatric Hospital ◽  
Inpatient Settings ◽  
Surgical Teams

Children in hospital are frequently prescribed intravenous antibiotics for longer than needed. Programmes to optimise timely intravenous-to-oral antibiotic switch may limit excessive in-hospital antibiotic use, minimise complications of intravenous therapy and allow children to go home faster. Here, we describe a quality improvement approach to implement a guideline, with team-based education, audit and feedback, for timely, safe switch from intravenous-to-oral antibiotics in hospitalised children. Eligibility for switch was based on evidence-based guidelines and supported by education and feedback. The project was conducted over 12 months in a tertiary paediatric hospital. Primary outcomes assessed were the proportion of eligible children admitted under paediatric and surgical teams switched within 24 hours, and switch timing prior to and after guideline launch. Secondary outcomes were hospital length of stay, recommencement of intravenous therapy or readmission. The percentage of children switched within 24 hours of eligibility significantly increased from 32/50 (64%) at baseline to 203/249 (82%) post-implementation (p=0.006). The median time to switch fell from 15 hours 42 min to 4 hours 20 min (p=0.0006). In addition, there was a 14-hour median reduction in hospital length of stay (p=0.008). Readmission to hospital and recommencement of intravenous therapy did not significantly change postimplementation. This education, audit and feedback approach improved timely intravenous-to-oral switch in children and also allowed for more timely discharge from hospital. The study demonstrates proof of concept for this implementation with a methodology that can be readily adapted to other paediatric inpatient settings.

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