Berrevoets Marvin Ah, Ten Oever Jaap, Sprong Tom, van Hest Reinier M, Groothuis Ingeborg, van Heijl Inger, Schouten Jeroen A, Hulscher Marlies E, Kullberg Bart-Jan
Department of Internal Medicine, Division of Infectious Diseases, Radboud university medical center, Nijmegen, The Netherlands.
Radboud Center for Infectious Diseases, Radboud university medical center, Nijmegen, The Netherlands.
BMC Infect Dis. 2017 Aug 15;17(1):565. doi: 10.1186/s12879-017-2673-5.
The Dutch Working Party on Antibiotic Policy is developing a national antimicrobial stewardship registry. This registry will report both the quality of antibiotic use in hospitals in the Netherlands and the stewardship activities employed. It is currently unclear which aspects of the quality of antibiotic use are monitored by antimicrobial stewardship teams (A-teams) and can be used as indicators for the stewardship registry. In this pilot study we aimed to determine which stewardship objectives are eligible for the envisioned registry.
We performed an observational pilot study among five Dutch hospitals. We assessed which of the 14 validated stewardship objectives (11 process of care recommendations and 3 structure of care recommendations) the A-teams monitored and documented in individual patients. They provided, where possible, data to compute quality indicator (QI) performance scores in line with recently developed QIs to measure appropriate antibiotic use in hospitalized adults for the period of January 2015 through December 2015 RESULTS: All hospitals had a local antibiotic guideline describing recommended antimicrobial use. All A-teams monitored the performance of bedside consultations in Staphylococcus aureus bacteremia and the prescription of restricted antimicrobials. Documentation and reporting were the best for the use of restricted antimicrobials: 80% of the A-teams could report data. Lack of time and the absence of an electronic medical record system enabling documentation during the daily work flow were the main barriers hindering documentation and reporting.
Five out of 11 stewardship objectives were actively monitored by A-teams. Without extra effort, 4 A-teams could report on the quality of use of restricted antibiotics. Therefore, this aspect of antibiotic use should be the starting point of the national antimicrobial stewardship registry. Our registry is expected to become a powerful tool to evaluate progress and impact of antimicrobial stewardship programs in hospitals.
荷兰抗生素政策工作小组正在建立一个全国性抗菌药物管理登记系统。该登记系统将报告荷兰医院抗生素使用的质量以及所采用的管理活动。目前尚不清楚抗菌药物管理团队（A组）监测抗生素使用质量的哪些方面，以及这些方面能否用作管理登记系统的指标。在这项试点研究中，我们旨在确定哪些管理目标适用于设想中的登记系统。
我们在五家荷兰医院开展了一项观察性试点研究。我们评估了A组在个体患者中监测和记录的14项经过验证的管理目标（11项护理过程建议和3项护理结构建议）中的哪些目标。他们尽可能提供数据，以根据最近制定的质量指标（QI）计算2015年1月至2015年12月期间住院成人适当使用抗生素的QI绩效得分。结果：所有医院都有描述推荐抗菌药物使用的当地抗生素指南。所有A组都监测了金黄色葡萄球菌菌血症床边会诊的执行情况以及限制使用抗菌药物的处方。限制使用抗菌药物的记录和报告情况最好：80%的A组能够报告数据。时间不足以及缺乏在日常工作流程中实现记录的电子病历系统是阻碍记录和报告的主要障碍。
A组积极监测了11项管理目标中的5项。在没有额外努力的情况下，4个A组能够报告限制使用抗生素的使用质量。因此，抗生素使用的这一方面应成为全国抗菌药物管理登记系统的起点。我们的登记系统有望成为评估医院抗菌药物管理计划进展和影响的有力工具。
