Design of a 'day 3 bundle' to improve the reassessment of inpatient empirical antibiotic prescriptions.
J Antimicrob Chemother
; 61(6): 1384-8, 2008 Jun.
Article
em En
| MEDLINE
| ID: mdl-18367462
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 > or = 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.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Terapêutica
/
Infecções Bacterianas
/
Serviços de Saúde
/
Antibacterianos
Tipo de estudo:
Diagnostic_studies
/
Prognostic_studies
Limite:
Humans
Idioma:
En
Ano de publicação:
2008
Tipo de documento:
Article