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Guideline Implementation to Decrease Inappropriate Bacteriuria Treatment

减少不适当菌尿治疗的指南实施

基本信息

批准号：
8600170
负责人：
BARBARA Wells TRAUTNER
金额：
--
依托单位：
MICHAEL E DEBAKEY VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-04-01 至 2013-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8600170
关键词：
Acute Address Adherence Adverse effects Advisory Committees Americas Antibiotics Antimicrobial Resistance Attention Attitude Awareness Bacteremia Bacteriuria Belief Beryllium Blinded Caring Catheters Centers for Disease Control and Prevention (U.S.)Climate Clinical Clinical Practice Guideline Communicable Diseases Diagnosis Disease Education Effectiveness Elements Expectancy Familiarity Feedback Futility Goals Guideline Adherence Guidelines Health Personnel Healthcare Healthcare Systems Hospitals Human Resources Incidence Individual Infection Inpatients Institution Intervention Knowledge Lead Long-Term Care Measurable Measurement Measures Medical center Medicine Methods Monitor Multi-Drug Resistance Nosocomial Infections Outcome Patients Persons Population Study Practice Guidelines Prevention Preventive Process Provider Published Practice Guidelines Publishing Pyelonephritis Quality of Care Reporting Research Resistance Safety Services Site Societies South Texas Subacute Care Surveys System Telephone Treatment Cost Urinary tract infection Urine Veterans antimicrobial base catheter associated UTI clinical practice clinically significant cost cost effectiveness disorder prevention evidence base evidence based guidelines implementation research improved individualized feedback insight intervention effect nosocomial UTI pathogen pressure prevent screening urinary ward

项目摘要

Anticipated Impacts on Veterans' Healthcare: Urinary tract infection (UTI) is the single most common hospital-acquired infection. However, the majority of cases of nosocomial catheter- associated urinary tract infection (CAUTI) are really asymptomatic bacteriuria (ABU). ABU is not a clinically significant condition, and treatment is unlikely to confer benefit. Overtreatment of ABU is a quality, safety, and cost issue, particularly as unnecessary antibiotics lead to emergence of resistant flora. Our proposal to bring clinical practice in line with published guidelines has significant potential to decrease CAUTI and associated inappropriate antibiotic use in VA hospitals. Our study will also provide information about how to maximize effectiveness of audit- feedback to achieve guideline adherence in the inpatient VA setting. Project Background/Rationale: Evidence-based guidelines recommend that providers neither screen for nor treat ABU in most catheterized patients. However, a significant gap between these guidelines and clinical practice has been documented at our VA hospital and throughout the world. Since many VA patients in both acute care settings and sub-acute care settings, such as intermediate and long-term care, have a legitimate need for a urinary catheter, the issue of overtreatment of catheter-associated ABU is an active problem for the VA. Project Objectives: We hypothesize that implementing the existing evidence-based guidelines about non-treatment of ABU will dramatically reduce the unnecessary use of antibiotics to treat ABU and the incidence of incorrectly diagnosed CAUTI. Our first objective is to improve quality of care concerning ABU in terms of specific clinical outcomes (inappropriate screening for and treatment of ABU) through implementation of an audit-feedback strategy. We also hypothesize that successful implementation of an audit-feedback strategy will result in measurable changes in clinicians' knowledge and attitudes concerning ABU practice guidelines. Our second objective is to assess through surveys the effect of the implementation on clinicians' guideline awareness, familiarity, acceptance, and outcome expectancy. Project Methods: Our guidelines implementation strategy will employ audit-feedback, applied as a post-prescription antimicrobial review based on established guidelines. The study population for the clinical outcomes is all inpatients on certain wards at the intervention site (Houston VA) and the control site (San Antonio VA). Our study population for the audit-feedback intervention and surveys is the health care providers on these wards. We propose a 3-year study. During the first year we will observe the baseline incidence of inappropriate screening for and treatment of ABU at both sites. Blinded monitoring of clinical outcomes will continue during the next 2 years of the study. During the second year, we will distribute the guidelines at both sites. Clinicians at the intervention site will receive individualized feedback, either by telephone or in person, about whether their management of bacteriuria was guideline-compliant. Unit-level feedback will also be provided. During the third year, individualized feedback will cease, but unit-level feedback will continue as this constitutes a sustainable intervention. Clinicians will complete pre/post surveys of awareness, familiarity, acceptance, and outcome expectancy at the intervention site in year 2 and at both sites in year 3. Differences in outcomes between the individualized intervention in year 2 and the group-level intervention in year 3 will help to determine the necessary intensity of intervention for dissemination and implementation in other VA facilities.

对退伍军人医疗保健的预期影响：尿路感染（UTI）是最单一的