From guidelines to practice: a pharmacist-driven prospective audit and feedback improvement model for peri-operative antibiotic prophylaxis in 34 South African hospitals
From guidelines to practice: a pharmacist-driven prospective audit and feedback improvement model for peri-operative antibiotic prophylaxis in 34 South African hospitals
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DOI：
10.1093/jac/dkw523
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发表时间：
2017-04-01
影响因子：
5.2
通讯作者：
van den Bergh, Dena
中科院分区：
文献类型：
--
作者：
Brink, Adrian J.;Messina, Angeliki P.;van den Bergh, Dena
背景资料：在Africa.Objectives：为了利用现有资源实施PAP的改进模型，以减少南非34家城市和农村医院的手术部位感染（SSIs），我们采用了一种新的方法，以减少手术部位感染。方法：采用药剂师驱动的前瞻性稽查和反馈策略，涉及变更管理和改进原则。这项为期2.5年的干预措施包括实施前阶段，以在试点地点测试PAP指南和“工具包”。在抗菌药物管理委员会和临床医生认可后，在所有机构中引入了该模型，并对基线SSI和四个过程测量（抗生素选择，剂量，给药时间和持续时间）的依从率进行了调查。实施后阶段涉及审计，干预和每月的反馈，以促进改善compliance.Results：70周的标准化测量和反馈，24 206例手术病例进行了审查。所有过程测量的依从性（复合依从性）从66.8%（95%CI 64.8-68.7）显著改善至83.3%（95%CI 80.8-85.8），增加了24.7%（P < 0.0001）。SSI发生率从平均组发生率2.46%下降了19.7%（95% CI 2.18-2.73）干预前至干预后1.97（95% CI 1.79-2.15）（P = 0.0029）。利用药剂师实施针对机构需求的流程改进计划和原则，可以有效地提高PAP指南的依从性，可持续的患者结果。
Background: Few data exist on the implementation of process measures to facilitate adherence to perioperative antibiotic prophylaxis (PAP) guidelines in Africa.Objectives: To implement an improvement model for PAP utilizing existing resources, in order to achieve a reduction in surgical site infections (SSIs) across a heterogeneous group of 34 urban and rural South African hospitals.Methods: A pharmacist-driven, prospective audit and feedback strategy involving change management and improvement principles was utilized. This 2.5 year intervention involved a pre-implementation phase to test a PAP guideline and a 'toolkit' at pilot sites. Following antimicrobial stewardship committee and clinician endorsement, the model was introduced in all institutions and a survey of baseline SSI and compliance rates with four process measures (antibiotic choice, dose, administration time and duration) was performed. The post-implementation phase involved audit, intervention and monthly feedback to facilitate improvements in compliance.Results: For 70 weeks of standardized measurements and feedback, 24 206 surgical cases were reviewed. There was a significant improvement in compliance with all process measures (composite compliance) from 66.8% (95% CI 64.8-68.7) to 83.3% (95% CI 80.8-85.8), representing a 24.7% increase (P < 0.0001). The SSI rate decreased by 19.7% from a mean group rate of 2.46 (95% CI 2.18-2.73) pre-intervention to 1.97 post-intervention (95% CI 1.79-2.15) (P = 0.0029).Conclusions: The implementation of process improvement initiatives and principles targeted to institutional needs utilizing pharmacists can effectively improve PAP guideline compliance and sustainable patient outcomes.