Pulcini Céline, Defres Sylviane, Aggarwal Ila, Nathwani Dilip, Davey Peter
Service d'Infectiologie, Hôpital l'Archet 1, Centre Hospitalier Universitaire de Nice, Route St Antoine de Ginestière, BP 3079, 06202 Nice Cedex 3, France.
J Antimicrob Chemother. 2008 Jun;61(6):1384-8. doi: 10.1093/jac/dkn113. Epub 2008 Mar 26.
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.
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.
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.
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.
制定并测试一套用于重新评估住院患者经验性抗生素处方的医疗质量过程指标，确定在评估这些指标时病历审查的评分者间信度，并在一个病房对这些指标进行测试。
通过文献综述确定医疗护理过程指标。由两名独立医生对40套病历进行审查，并使用观察到的百分比一致性和kappa统计量确定评分者间信度。每周收集这些指标并反馈给医生以促进改进。
确定了四项过程指标，并将其归为一组形成“第3天捆绑指标”：抗生素治疗方案、诊断复查、根据微生物学结果调整用药以及静脉转口服治疗。所有指标的评分者间一致性均≥80%。数据收集可行且在数周内易于持续进行。通过向医疗团队实时反馈指标，对第3天左右的抗生素处方重新评估有了更好的记录。
我们的护理指标适用于住院患者经验性抗生素处方的重新评估，评分者间信度良好。这种质量干预应成为改善医院抗生素使用的更全面、多方面计划的一部分。
