以审核与反馈为重点的医院肺炎患者循证护理方法（AFFECT研究）

Audit and Feedback-Focused approach to Evidence-based Care in Treating patients with pneumonia in hospital (AFFECT Study).

作者信息

Halpape Katelyn, Sulz Linda, Schuster Brenda, Taylor Ron

机构信息

, BSP, ACPR, is a PharmD student in the Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia. She completed her pharmacy practice residency with the Regina Qu'Appelle Health Region, Regina, Saskatchewan, in 2012/2013.

, BSP, PharmD, is with Regina Qu'Appelle Health Region, Regina, Saskatchewan.

出版信息

Can J Hosp Pharm. 2014 Jan;67(1):17-27. doi: 10.4212/cjhp.v67i1.1317.

DOI:10.4212/cjhp.v67i1.1317

PMID:24634522

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3952903/

Abstract

BACKGROUND

Pneumonia is the eighth leading cause of death in Canada. Use of guideline-concordant therapy tempers the development of resistance, decreases health care costs, and reduces morbidity and mortality.

OBJECTIVES

The purpose of this study was to optimize the treatment of patients with pneumonia under hospitalist care by focusing on best practice and local antibiogram data. The objectives were to collaborate with a hospitalist representative to optimize in-hospital treatment of patients with community-acquired, hospital-acquired, and health care-associated pneumonia; to complete a baseline audit to determine the proportion of antibiotic orders adhering to the strategy; to present the strategy and baseline audit findings to the hospitalists; to perform a post-intervention audit, with comparison to baseline, and to present results to the hospitalists; to expedite de-escalation to a narrower-spectrum antibiotic; to expedite parenteral-to-oral step-down therapy and promote appropriate duration of therapy; and to determine if a pneumonia scoring system was used.

METHODS

An audit and feedback intervention focusing on pre- and post-intervention retrospective chart audits was completed. Review of pneumonia guidelines and the local antibiogram assisted in identifying the study strategy. A presentation to the hospitalists outlined antimicrobial stewardship principles and described the findings of the baseline audit. Pre- and post-intervention audit results were compared.

RESULTS

Local best-practice treatment algorithms were developed for community-acquired pneumonia and for hospital-acquired and health care-associated pneumonia. The pre-intervention audit covered the period December 2011 to January 2012, with subsequent education and audit results presented to the hospitalists in November 2012. The post-intervention audit covered the period December 2012 to January 2013. Adherence to the treatment algorithms increased from 10% (2/21) in the pre-intervention audit to 38% (5/13) in the post-intervention audit. There was a trend to reduced duration of therapy in the post-intervention group.

CONCLUSION

An audit and feedback intervention related to hospitalists' prescribing for pneumonia increased adherence to local best practice.

摘要

背景

肺炎是加拿大第八大死因。采用符合指南的治疗方法可抑制耐药性的发展，降低医疗成本，并减少发病率和死亡率。

目的

本研究的目的是通过关注最佳实践和当地抗菌谱数据，优化住院医师护理下肺炎患者的治疗。目标包括与住院医师代表合作，优化社区获得性肺炎、医院获得性肺炎和医疗保健相关肺炎患者的院内治疗；完成基线审核，以确定遵循该策略的抗生素医嘱比例；向住院医师介绍该策略和基线审核结果；进行干预后审核，并与基线进行比较，然后向住院医师汇报结果；加快降级使用窄谱抗生素；加快从肠外给药转为口服给药的降阶梯治疗，并促进适当的治疗疗程；以及确定是否使用了肺炎评分系统。

方法

完成了一项侧重于干预前和干预后回顾性病历审核的审核与反馈干预措施。对肺炎指南和当地抗菌谱的审查有助于确定研究策略。向住院医师进行的一次汇报概述了抗菌药物管理原则，并描述了基线审核的结果。比较了干预前和干预后的审核结果。

结果

针对社区获得性肺炎以及医院获得性肺炎和医疗保健相关肺炎制定了当地最佳实践治疗算法。干预前审核涵盖2011年12月至2012年1月期间，随后在2012年11月将教育及审核结果汇报给住院医师。干预后审核涵盖2012年12月至2013年1月期间。遵循治疗算法的比例从干预前审核中的10%（2/21）增至干预后审核中的38%（5/13）。干预后组的治疗疗程有缩短趋势。