A Performance Improvement Monitor: Criteria for Antibiotic Therapy

Abstract

ISSUE: Despite CDC and state health department campaigns, inappropriate use of antibiotics continues to be an issue in health care facilities. Excessive and unneccesary antibiotic usage contributes to the development of antibiotic resistant organisms and is often responsible for adverse side effects. There is often inconsistency in adhering to consistent, established criteria for initiating antibiotic therapy(ABT). PROJECT: A Performance Improvement Monitor was initated at our facility in January 2005 with the primary indicator, “Appropriate Use of Antibiotics.” The criteria selected for monitoring were: A.fever above 100°F. for 24 hours B.positive culture (along with abnormal urinalysis if UTI) C.abnormal CXR with respiratory signs and symptoms D.WBC over 11.0 with left shift E.other criteria (addressed in data analysis: example-prophylaxis for traumatic laceration; cellulitis) An Excel data collection tool was developed. Study parameters were presented at a Medical Staff Meeting prior to the initiation of the project. METHODOLOGY: Patients on one clinical unit were reviewed. A weekly antibiotic listing was received from pharmacy. IC Director reviewed charts of all pts. on antibiotics. RESULTS: Once physicians became aware of the existence and parameters of this monitor, there was an observable change in antibiotic prescribing patterns. Physicians on this unit became more consistent in documenting clinical rationale for antibiotic use. Over the time frame of this project, there has been an improvement in prescribing practices. Indicator compliance - 1st quarter-72% (N = 62) 2nd quarter-93% (N = 60) 3r quarter-92% (N = 55) 4th quarter-90% (N = 59) Data is reported quarterly to individual physicians so they may review their prescribing patterns. This report includes patient specific information relevant to each antibiotic ordered, along with area of noncompliance. LESSONS LEARNED: This monitor has been instrumental in improving the antibiotic prescribing practices on this unit at our facility. As a result of the study, support staff have been educated on ABT and proper specimen collection. Quarterly compliance rates for the unit are shared with nurses at staff meetings. As a result, the nursing staff became more aware of the issue of antibiotic overuse, as well as proper specimen collection protocols. This was a challenging project to implement as there were no data collection parameters or tools available in the literature. ISSUE: Despite CDC and state health department campaigns, inappropriate use of antibiotics continues to be an issue in health care facilities. Excessive and unneccesary antibiotic usage contributes to the development of antibiotic resistant organisms and is often responsible for adverse side effects. There is often inconsistency in adhering to consistent, established criteria for initiating antibiotic therapy(ABT). PROJECT: A Performance Improvement Monitor was initated at our facility in January 2005 with the primary indicator, “Appropriate Use of Antibiotics.” The criteria selected for monitoring were: A.fever above 100°F. for 24 hours B.positive culture (along with abnormal urinalysis if UTI) C.abnormal CXR with respiratory signs and symptoms D.WBC over 11.0 with left shift E.other criteria (addressed in data analysis: example-prophylaxis for traumatic laceration; cellulitis) An Excel data collection tool was developed. Study parameters were presented at a Medical Staff Meeting prior to the initiation of the project. METHODOLOGY: Patients on one clinical unit were reviewed. A weekly antibiotic listing was received from pharmacy. IC Director reviewed charts of all pts. on antibiotics. RESULTS: Once physicians became aware of the existence and parameters of this monitor, there was an observable change in antibiotic prescribing patterns. Physicians on this unit became more consistent in documenting clinical rationale for antibiotic use. Over the time frame of this project, there has been an improvement in prescribing practices. Indicator compliance - 1st quarter-72% (N = 62) 2nd quarter-93% (N = 60) 3r quarter-92% (N = 55) 4th quarter-90% (N = 59) Data is reported quarterly to individual physicians so they may review their prescribing patterns. This report includes patient specific information relevant to each antibiotic ordered, along with area of noncompliance. LESSONS LEARNED: This monitor has been instrumental in improving the antibiotic prescribing practices on this unit at our facility. As a result of the study, support staff have been educated on ABT and proper specimen collection. Quarterly compliance rates for the unit are shared with nurses at staff meetings. As a result, the nursing staff became more aware of the issue of antibiotic overuse, as well as proper specimen collection protocols. This was a challenging project to implement as there were no data collection parameters or tools available in the literature.