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Quality of documentation on antibiotic therapy in medical records: evaluation of combined interventions in a teaching hospital by repeated point prevalence survey

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Abstract

This study aimed to improve the quality of documentation on antibiotic therapy in the computerized medical records of inpatients. A prospective, uncontrolled, interrupted time series (ITS) study was conducted by repeated point prevalence survey (PPS) to audit the quality of documentation on antibiotic therapy in the medical records before and after a combined intervention strategy (implementation of guidelines, distribution of educational materials, educational outreach visits, group educational interactive sessions) from the antimicrobial stewardship team (AST) in the academic teaching hospital (CHU) of Liège, Belgium. The primary outcome measure was the documentation rate on three quality indicators in the computerized medical records: (1) indication for treatment, (2) antibiotics prescribed, and (3) duration or review date. Segmented regression analysis was used to analyze the ITS. The medical records of 2306 patients receiving antibiotics for an infection (1177 in the pre-intervention period and 1129 in the post-intervention period) were analyzed. A significant increase in mean percentages in the post-intervention period was observed as compared with the pre-intervention period for the three quality indicators (indication documented 83.4 ± 10.4 % vs. 90.3 ± 6.6 %, p = 0.0013; antibiotics documented 87.9 ± 9.0 % vs. 95.6 ± 5.1 %, p < 0.0001; and duration or review date documented 31.9 ± 15.4 % vs. 67.7 ± 15.2 %, p < 0.0001). The study demonstrated the successful implementation of a combined intervention strategy from the AST. This strategy was associated with significant changes in the documentation rate in the computerized medical records for the three quality indicators.

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References

  1. European Centre for Disease Prevention and Control (ECDC) (2014) Surveillance report. Antimicrobial resistance surveillance in Europe 2013. ECDC, Stockholm. doi:10.2900/39777

  2. Frieden T (2013) Antibiotic resistance threats in the United States, 2013. Centers for Disease Control and Prevention (CDC), 114 pp

  3. Boucher HW, Talbot GH, Bradley JS, Edwards JE, Gilbert D, Rice LB et al (2009) Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis 48:1–12. doi:10.1086/595011

    Article  PubMed  Google Scholar 

  4. Van Gastel E, Costers M, Peetermans WE, Struelens MJ; Hospital Medicine Working Group of the Belgian Antibiotic Policy Coordination Committee (2010) Nationwide implementation of antibiotic management teams in Belgian hospitals: a self-reporting survey. J Antimicrob Chemother 65:576–580. doi:10.1093/jac/dkp470

    Article  PubMed  Google Scholar 

  5. Allerberger F, Mittermayer H (2008) Antimicrobial stewardship. Clin Microbiol Infect 14:197–199. doi:10.1111/j.1469-0691.2007.01929.x

    Article  CAS  PubMed  Google Scholar 

  6. Dellit TH, Owens RC, McGowan JE Jr, Gerding DN, Weinstein RA, Burke JP et al (2007) Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 44:159–177. doi:10.1086/510393

    Article  PubMed  Google Scholar 

  7. Van Gastel E, Balligand E, Costers M, Magerman K; Hospital Medicine Working Group of the Belgian Antibiotic Policy Coordination Committee (2015) Antibiotic management teams in Belgian hospitals: continued improvement in the period from 2007 to 2011. Eur J Clin Microbiol Infect Dis 34:673–677. doi:10.1007/s10096-014-2279-4

    Article  PubMed  Google Scholar 

  8. Willemsen I, Groenhuijzen A, Bogaers D, Stuurman A, van Keulen P, Kluytmans J (2007) Appropriateness of antimicrobial therapy measured by repeated prevalence surveys. Antimicrob Agents Chemother 51:864–867. doi:10.1128/AAC.00994-06

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Zarb P, Amadeo B, Muller A, Drapier N, Vankerckhoven V, Davey P et al (2011) Identification of targets for quality improvement in antimicrobial prescribing: the web-based ESAC Point Prevalence Survey 2009. J Antimicrob Chemother 66:443–449. doi:10.1093/jac/dkq430

    Article  CAS  PubMed  Google Scholar 

  10. Ansari F, Erntell M, Goossens H, Davey P (2009) The European surveillance of antimicrobial consumption (ESAC) point-prevalence survey of antibacterial use in 20 European hospitals in 2006. Clin Infect Dis 49:1496–1504. doi:10.1086/644617

    Article  PubMed  Google Scholar 

  11. Department of Health, ESPAUR SSTF subcommittee (2015) Start smart - then focus. Antimicrobial stewardship toolkit for English Hospitals. 26 pp

  12. Malcolm W, Nathwani D, Davey P, Cromwell T, Patton A, Reilly J et al (2013) From intermittent antibiotic point prevalence surveys to quality improvement: experience in Scottish hospitals. Antimicrob Resist Infect Control 2:3. doi:10.1186/2047-2994-2-3

    Article  PubMed  PubMed Central  Google Scholar 

  13. Cooke FJ, Matar R, Lawson W, Aliyu SH, Holmes A (2010) Comment on: antibiotic stewardship—more education and regulation not more availability? J Antimicrob Chemother 65:598. doi:10.1093/jac/dkp481

    Article  CAS  PubMed  Google Scholar 

  14. Gloucestershire Hospitals NHS Foundation Trust (2013) Antibiotic stop/review date and indication policy, 6 pp

  15. Cooke FJ, Holmes AH (2007) The missing care bundle: antibiotic prescribing in hospitals. Int J Antimicrob Agents 30:25–29. doi:10.1016/j.ijantimicag.2007.03.003

    Article  CAS  PubMed  Google Scholar 

  16. Cochrane Effective Practice and Organisation of Care Review Group (EPOC) (2002) Data collection checklist. Accessed 27 May 2014

  17. Ramsay C, Brown E, Hartman G, Davey P (2003) Room for improvement: a systematic review of the quality of evaluations of interventions to improve hospital antibiotic prescribing. J Antimicrob Chemother 52:764–771. doi:10.1093/jac/dkg460

    Article  CAS  PubMed  Google Scholar 

  18. Wagner AK, Soumerai SB, Zhang F, Ross-Degnan D (2002) Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther 27:299–309. doi:10.1046/j.1365-2710.2002.00430.x

    Article  CAS  PubMed  Google Scholar 

  19. Delory T, De Pontfarcy A, Emirian A, About F, Berdougo B, Brun-Buisson C et al (2013) Impact of a program combining pre-authorization requirement and post-prescription review of carbapenems: an interrupted time-series analysis. Eur J Clin Microbiol Infect Dis 32:1599–1604. doi:10.1007/s10096-013-1918-5

    Article  CAS  PubMed  Google Scholar 

  20. Fowler S, Webber A, Cooper BS, Phimister A, Price K, Carter Y et al (2007) Successful use of feedback to improve antibiotic prescribing and reduce Clostridium difficile infection: a controlled interrupted time series. J Antimicrob Chemother 59:990–995. doi:10.1093/jac/dkm014

    Article  CAS  PubMed  Google Scholar 

  21. Aldeyab MA, Kearney MP, McElnay JC, Magee FA, Conlon G, MacIntyre J et al (2012) A point prevalence survey of antibiotic use in four acute-care teaching hospitals utilizing the European Surveillance of Antimicrobial Consumption (ESAC) audit tool. Epidemiol Infect 140:1714–1720. doi:10.1017/S095026881100241X

    Article  CAS  PubMed  Google Scholar 

  22. van Spreuwel PCJM, Blok H, Langelaar MFM, Kullberg BJ, Mouton JW, Natsch S (2015) Identifying targets for quality improvement in hospital antibiotic prescribing. Neth J Med 73:161–168

    PubMed  Google Scholar 

  23. Cotta MO, Robertson MS, Upjohn LM, Marshall C, Liew D, Buising KL (2014) Using periodic point-prevalence surveys to assess appropriateness of antimicrobial prescribing in Australian private hospitals. Intern Med J 44:240–246. doi:10.1111/imj.12353

    Article  CAS  PubMed  Google Scholar 

  24. Hansen S, Sohr D, Piening B, Pena Diaz L, Gropmann A, Leistner R et al (2013) Antibiotic usage in German hospitals: results of the second national prevalence study. J Antimicrob Chemother 68:2934–2939. doi:10.1093/jac/dkt292

    Article  CAS  PubMed  Google Scholar 

  25. Toth NR, Chambers RM, Davis SL (2010) Implementation of a care bundle for antimicrobial stewardship. Am J Health Syst Pharm 67:746–749. doi:10.2146/ajhp090259

    Article  PubMed  Google Scholar 

  26. Coll A, Kinnear M, Kinnear A (2012) Design of antimicrobial stewardship care bundles on the high dependency unit. Int J Clin Pharm 34:845–854. doi:10.1007/s11096-012-9680-9

    Article  PubMed  Google Scholar 

  27. Chaves NJ, Ingram RJ, MacIsaac CM, Buising KL (2014) Sticking to minimum standards: implementing antibiotic stewardship in intensive care. Intern Med J 44:1180–1187. doi:10.1111/imj.12539

    Article  CAS  PubMed  Google Scholar 

  28. Roberts E, Dawoud DM, Hughes DA, Cefai C (2015) Evaluation of a consultant audit and feedback programme to improve the quality of antimicrobial prescribing in acute medical admissions. Int J Pharm Pract 23:333–339. doi:10.1111/ijpp.12173

    Article  PubMed  Google Scholar 

  29. Pulcini C, Defres S, Aggarwal I, Nathwani D, Davey P (2008) Design of a ‘day 3 bundle’ to improve the reassessment of inpatient empirical antibiotic prescriptions. J Antimicrob Chemother 61:1384–1388. doi:10.1093/jac/dkn113

    Article  CAS  PubMed  Google Scholar 

  30. Willemsen I, van der Kooij T, van Benthem B, Wille J, Kluytmans J (2010) Appropriateness of antimicrobial therapy: a multicentre prevalence survey in the Netherlands, 2008–2009. Eur Surveill 15. pii: 19715

  31. Cusini A, Rampini SK, Bansal V, Ledergerber B, Kuster SP, Ruef C et al (2010) Different patterns of inappropriate antimicrobial use in surgical and medical units at a tertiary care hospital in Switzerland: a prevalence survey. PLoS One 5:e14011. doi:10.1371/journal.pone.0014011

    Article  PubMed  PubMed Central  Google Scholar 

  32. Akhloufi H, Streefkerk RH, Melles DC, de Steenwinkel JEM, Schurink CAM, Verkooijen RP et al (2015) Point prevalence of appropriate antimicrobial therapy in a Dutch university hospital. Eur J Clin Microbiol Infect Dis 34:1631–1637. doi:10.1007/s10096-015-2398-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Gyssens IC (2001) Quality measures of antimicrobial drug use. Int J Antimicrob Agents 17:9–19. doi:10.1016/S0924-8579(00)00208-9

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We would like to thank the clinical staff involved in this study, P. Papineni for the language revision, and C. Achen for the helpful comments.

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Authors and Affiliations

  1. Department of Clinical Pharmacy, CIRM (Center for Interdisciplinary Research on Medicines), University Hospital of Liège, Liège, Belgium

    C. Vercheval, M. Gillet & T. Van Hees

  2. Service de Pharmacie Clinique, CHU de Liège, Avenue de l’hôpital, 1 - B35, Sart Tilman, 4000, Liège, Belgium

    C. Vercheval

  3. Department of Biostatistics and Medico-Economic Information, University Hospital of Liège, Liège, Belgium

    N. Maes & A. Albert

  4. Department of Infectious Diseases and General Internal Medicine, University Hospital of Liège, Liège, Belgium

    F. Frippiat

  5. Department of Intensive Care Unit, University Hospital of Liège, Liège, Belgium

    P. Damas

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  1. C. Vercheval
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Correspondence to C. Vercheval.

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The authors declare that they have no conflicts of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Vercheval, C., Gillet, M., Maes, N. et al. Quality of documentation on antibiotic therapy in medical records: evaluation of combined interventions in a teaching hospital by repeated point prevalence survey. Eur J Clin Microbiol Infect Dis 35, 1495–1500 (2016). https://doi.org/10.1007/s10096-016-2690-0

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