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.

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

“…Therapy duration is increasingly an important focus area for antimicrobial stewardship activity. However, expected applicability was below 10% based on previous studies [ 9 , 13 , 22 ]. Therefore, we excluded these QIs in the final selection.…”

Appropriateness of Antibiotic Treatment Review following Blood Culture Collection

“…34 In 2015, in a study where inappropriateness was determined by the absence of antimicrobials with activity against the isolated microorganism, inappropriateness was 12%. 35 However, these studies did not include children.…”

Developing and testing a set of quality indicators for pharmacist home visit services: A mixed methods study in Japan

“…Applicability: a QI was considered “inapplicable if the number of patients in the denominator accounted for <5% of a the patients amongst all pharmacies, measured at the final study month 28 Improvement potential: a QI was considered “no room for improvement” if 100% minus the QI score was <10% (ie, QI score ≥ 90%) at the sixth month (applicable only for QIs which were proportions) 28–30 Discriminatory capacity: a QI was considered “no discriminatory capacity” if the interquartile range of a QI score was <10%, measured at the final study month (applicable only for QIs which were proportions) 28,30 …”

“…28 • Improvement potential: a QI was considered "no room for improvement" if 100% minus the QI score was <10% (ie, QI score ≥ 90%) at the sixth month (applicable only for QIs which were proportions). [28][29][30] • Discriminatory capacity: a QI was considered "no discriminatory capacity" if the interquartile range of a QI score was <10%, measured at the final study month (applicable only for QIs which were proportions). 28,30 • Sensitivity to change: a QI was considered "sensitive to change" if the difference of the QI score between the beginning (first month) and the end (sixth month) of the pilot was statistically significant at a 95% confidence level.…”