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J Antimicrob Chemother. 2008 Jun;61(6):1384-8. doi: 10.1093/jac/dkn113. Epub 2008 Mar 26.

Design of a 'day 3 bundle' to improve the reassessment of inpatient empirical antibiotic prescriptions.

Author information

1
Service d'Infectiologie, Hôpital l'Archet 1, Centre Hospitalier Universitaire de Nice, Route St Antoine de Ginestière, BP 3079, 06202 Nice Cedex 3, France. pulcini.c@chu-nice.fr

Abstract

OBJECTIVES:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

PMID:
18367462
DOI:
10.1093/jac/dkn113
[Indexed for MEDLINE]

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