Hood Graeme, Hand Kieran S, Cramp Emma, Howard Philip, Hopkins Susan, Ashiru-Oredope Diane
Public Health England, London SE1 8UG, UK.
University Hospital Southampton NHS Foundation Trust and School of Health Sciences, University of Southampton, Southampton SO16 6YD, UK.
Antibiotics (Basel). 2019 Apr 29;8(2):49. doi: 10.3390/antibiotics8020049.
This study developed a patient-level audit tool to assess the appropriateness of antibiotic prescribing in acute National Health Service (NHS) hospitals in the UK. A modified Delphi process was used to evaluate variables identified from published literature that could be used to support an assessment of appropriateness of antibiotic use. At a national workshop, 22 infection experts reached a consensus to define appropriate prescribing and agree upon an initial draft audit tool. Following this, a national multidisciplinary panel of 19 infection experts, of whom only one was part of the workshop, was convened to evaluate and validate variables using questionnaires to confirm the relevance of each variable in assessing appropriate prescribing. The initial evidence synthesis of published literature identified 25 variables that could be used to support an assessment of appropriateness of antibiotic use. All the panel members reviewed the variables for the first round of the Delphi; the panel accepted 23 out of 25 variables. Following review by the project team, one of the two rejected variables was rephrased, and the second neutral variable was re-scored. The panel accepted both these variables in round two with a 68% response rate. Accepted variables were used to develop an audit tool to determine the extent of appropriateness of antibiotic prescribing at the individual patient level in acute NHS hospitals through infection expert consensus based on the results of a Delphi process.
本研究开发了一种患者层面的审核工具，以评估英国国民医疗服务体系（NHS）急性病医院抗生素处方的合理性。采用改良的德尔菲法来评估从已发表文献中识别出的变量，这些变量可用于支持对抗生素使用合理性的评估。在一次全国性研讨会上，22位感染专家达成共识，确定了合理处方的定义，并商定了审核工具的初稿。在此之后，召集了一个由19位感染专家组成的全国多学科小组，其中只有一位是研讨会成员，通过问卷调查来评估和验证变量，以确认每个变量在评估合理处方中的相关性。对已发表文献的初步证据综合分析确定了25个可用于支持抗生素使用合理性评估的变量。所有小组成员对第一轮德尔菲法的变量进行了评审；小组接受了25个变量中的23个。在项目团队进行评审后，两个被否决变量中的一个进行了重新表述，第二个中性变量重新进行了评分。小组在第二轮中以68%的回复率接受了这两个变量。基于德尔菲法的结果，通过感染专家的共识，使用接受的变量开发了一种审核工具，以确定NHS急性病医院个体患者层面抗生素处方的合理程度。
