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Use of a Structured Panel Process to Define Quality Metrics for Antimicrobial Stewardship Programs

Published online by Cambridge University Press:  02 January 2015

Andrew M. Morris ,
Stacey Brener ,
Linda Dresser ,
Nick Daneman ,
Timothy H. Dellit ,
Edina Avdic  and
Chaim M. Bell
Andrew M. Morris*
Affiliation:
Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada Department of Medicine, Division of Infectious Diseases, University of Toronto, Ontario, Canada
Stacey Brener
Affiliation:
Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada St. Michael's Hospital, Keenan Research Centre in the Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
Linda Dresser
Affiliation:
Department of Pharmacy, University Health Network, Toronto, Ontario, Canada Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada
Nick Daneman
Affiliation:
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Sunnybrook Health Sciences Centre, Division of Infectious Diseases, Toronto, Ontario, Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
Timothy H. Dellit
Affiliation:
Department of Quality Improvement and Infection Control, Harborview Medical Center, Seattle, Washington
Edina Avdic
Affiliation:
Antimicrobial Stewardship Program, Johns Hopkins Hospital, Department of Pharmacy, Baltimore, Maryland
Chaim M. Bell
Affiliation:
St. Michael's Hospital, Keenan Research Centre in the Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada Canadian Institutes for Health Research and Canadian Patient Safety Institute, Toronto, Ontario, Canada
*
Mount Sinai Hospital, 600 University Avenue, Suite 415, Toronto, ON M5G 1X5 ([email protected])
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Abstract

Introduction.

Antimicrobial stewardship programs are being implemented in health care to reduce inappropriate antimicrobial use, adverse events, Clostridium difficile infection, and antimicrobial resistance. There is no standardized approach to evaluate the impact of these programs.

Objective.

To use a structured panel process to define quality improvement metrics for evaluating antimicrobial stewardship programs in hospital settings that also have the potential to be used as part of public reporting efforts.

Design.

A multiphase modified Delphi technique.

Setting.

Paper-based survey supplemented with a 1-day consensus meeting.

Participants.

A 10-member expert panel from Canada and the United States was assembled to evaluate indicators for relevance, effectiveness, and the potential to aid quality improvement efforts.

Results.

There were a total of 5 final metrics selected by the panel: (1) days of therapy per 1000 patient-days; (2) number of patients with specific organisms that are drug resistant; (3) mortality related to antimicrobial-resistant organisms; (4) conservable days of therapy among patients with community-acquired pneumonia (CAP), skin and soft-tissue infections (SSTI), or sepsis and bloodstream infections (BSI); and (5) unplanned hospital readmission within 30 days after discharge from the hospital in which the most responsible diagnosis was one of CAP, SSTI, sepsis or BSI. The first and second indicators were also identified as useful for accountability purposes, such as public reporting.

Conclusion.

We have successfully identified 2 measures for public reporting purposes and 5 measures that can be used internally in healthcare settings as quality indicators. These indicators can be implemented across diverse healthcare systems to enable ongoing evaluation of antimicrobial stewardship programs and complement efforts for improved patient safety.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 5 , May 2012 , pp. 500 - 506
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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