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首页> 外文期刊>The Canadian journal of hospital pharmacy. >Audit and Feedback-Focused approach to Evidence-based Care in Treating patients with pneumonia in hospital (AFFECT Study)
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Audit and Feedback-Focused approach to Evidence-based Care in Treating patients with pneumonia in hospital (AFFECT Study)

机译：以审计和反馈为中心的循证护理方法在医院治疗肺炎患者中的作用（AFFECT研究）

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Background: Pneumonia is the eighth leading cause of death in Canada. Use of guideline-concordant therapy tempers the development of resistance, decreases health care costs, and reduces morbidity and mortality.Objectives: The purpose of this study was to optimize the treatment of patients with pneumonia under hospitalist care by focusing on best practice and local antibiogram data. The objectives were to collaborate with a hospitalist representative to optimize in-hospital treatment of patients with community-acquired, hospital-acquired, and health care-associated pneumonia; to complete a baseline audit to determine the proportion of antibiotic orders adhering to the strategy; to present the strategy and baseline audit findings to the hospitalists; to perform a post-intervention audit, with comparison to baseline, and to present results to the hospitalists; to expedite de-escalation to a narrower-spectrum antibiotic; to expedite parenteral-to-oral step-down therapy and promote appropriate duration of therapy; and to determine if a pneumonia scoring system was used.Methods: An audit and feedback intervention focusing on pre- and post-intervention retrospective chart audits was completed. Review of pneumonia guidelines and the local antibiogram assisted in identifying the study strategy. A presentation to the hospitalists outlined antimicrobial stewardship principles and described the findings of the baseline audit. Pre- and post-intervention audit results were compared.Results: Local best-practice treatment algorithms were developed for community-acquired pneumonia and for hospital-acquired and health care-associated pneumonia. The pre-intervention audit covered the period December 2011 to January 2012, with subsequent education and audit results presented to the hospitalists in November 2012. The post-intervention audit covered the period December 2012 to January 2013. Adherence to the treatment algorithms increased from 10% (2/21) in die pre-intervention audit to 38% (5/13) in the post-intervention audit. There was a trend to reduced duration of therapy in the post-intervention group.Conclusion: An audit and feedback intervention related to hospitalists' prescribing for pneumonia increased adherence to local best practice.
机译：背景：肺炎是加拿大第八大死亡原因。指南一致疗法的使用可减轻耐药性的发展，降低医疗保健成本并降低发病率和死亡率。目的：本研究旨在通过关注最佳实践和局部抗菌素来优化住院治疗下的肺炎患者的治疗数据。目的是与医院代表合作，以优化对社区获得性，医院获得性和卫生保健相关性肺炎患者的住院治疗;完成基准审核，以确定遵守该策略的抗生素订单比例;向医院医生介绍策略和基准审核结果;与基线比较，进行干预后审核，并将结果提交给住院医生;加速降级为窄谱抗生素;加快胃肠外-口服降压治疗并延长适当的治疗时间;方法：完成一项针对干预前和干预后回顾性图表审核的审核和反馈干预措施。审查肺炎指南和局部抗菌素有助于确定研究策略。向住院医生的介绍概述了抗菌素管理原则，并描述了基准审核的结果。结果：制定了针对社区获得性肺炎，医院获得性和卫生保健相关性肺炎的本地最佳实践治疗算法。干预前的审核覆盖了2011年12月至2012年1月，随后的教育和审核结果于2012年11月提交给了住院医生。干预后的审核覆盖了2012年12月至2013年1月。对治疗算法的遵循从10增至10干预前审核中的百分比（2/21）达到干预后审核中的38％（5/13）。干预后组的治疗时间有减少的趋势。结论：与住院医生处方肺炎有关的审计和反馈干预措施增加了对当地最佳实践的依从性。

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