Development of an antimicrobial stewardship intervention using a model of actionable feedback.
Development of an antimicrobial stewardship intervention using a model of actionable feedback.
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DOI：
10.1155/2012/150367
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发表时间：
2012-01-01
影响因子：
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通讯作者：
Larson, Elaine
中科院分区：
文献类型：
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作者：
Patel, Sameer J;Saiman, Lisa;Larson, Elaine
我们描述了审计和反馈干预的发展，以改善抗生素处方在新生儿重症监护病房（NICU）使用的理论框架。参与者包括主治医生，新生儿研究员，儿科住院医师和执业护士。干预是基于“可操作的反馈模式”，强调反馈应该是及时的，个性化的，非惩罚性的，并定制有效。我们发现无法为本研究中确定的参数提供实时反馈，因为我们必须收集和分析大量数据元素以评估抗生素的适当开始和持续，并且需要更长的间隔来检查抗生素使用的趋势。我们在焦点小组中了解到，NICU临床医生强烈反对分配抗生素处方的个人责任，因为他们认为这是一个共同的责任，由每个病人的实验室数据和临床过程。我们能够创造一个非惩罚性的气氛，这要归功于NICU主治医生的书面知情同意书，以及领导层的保证，即处方做法不会被用来评估工作表现。我们提供了定制的，有意义的反馈，整合了参与者的意见。在新生儿重症监护室环境中，调整“可操作反馈模型”的原则以提供抗菌药物处方实践的反馈具有挑战性。
We describe the development of an audit and feedback intervention to improve antibiotic prescribing in the neonatal intensive care unit (NICU) using a theoretical framework. Participants included attending physicians, neonatal fellows, pediatric residents, and nurse practitioners. The intervention was based on the "model of actionable feedback" which emphasizes that feedback should be timely, individualized, nonpunitive, and customized to be effective. We found that real-time feedback could not be provided for the parameters established in this study, as we had to collect and analyze numerous data elements to assess appropriate initiation and continuation of antibiotics and required longer intervals to examine trends in antibiotic use. We learned during focus groups that NICU clinicians strongly resisted assigning individual responsibility for antibiotic prescribing as they viewed this as a shared responsibility informed by each patient's laboratory data and clinical course. We were able to create a non-punitive atmosphere thanks to written informed consent from NICU attendings and assurance from leadership that prescribing practices would not be used to assess job performance. We provided customized, meaningful feedback integrating input from the participants. Adapting the principles of the "model of actionable feedback" to provide feedback for antimicrobial prescribing practices proved challenging in the NICU setting.