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Measuring appropriate antibiotic prescribing in acute hospitals: development of a national audit tool through a Delphi consensus

Measuring appropriate antibiotic prescribing in acute hospitals: development of a national audit tool through a Delphi consensus
Measuring appropriate antibiotic prescribing in acute hospitals: development of a national audit tool through a Delphi consensus

This study developed a patient-level audit tool to assess the appropriateness of antibiotic prescribing in acute National Health Service (NHS) hospitals in the UK. A modified Delphi process was used to evaluate variables identified from published literature that could be used to support an assessment of appropriateness of antibiotic use. At a national workshop, 22 infection experts reached a consensus to define appropriate prescribing and agree upon an initial draft audit tool. Following this, a national multidisciplinary panel of 19 infection experts, of whom only one was part of the workshop, was convened to evaluate and validate variables using questionnaires to confirm the relevance of each variable in assessing appropriate prescribing. The initial evidence synthesis of published literature identified 25 variables that could be used to support an assessment of appropriateness of antibiotic use. All the panel members reviewed the variables for the first round of the Delphi; the panel accepted 23 out of 25 variables. Following review by the project team, one of the two rejected variables was rephrased, and the second neutral variable was re-scored. The panel accepted both these variables in round two with a 68% response rate. Accepted variables were used to develop an audit tool to determine the extent of appropriateness of antibiotic prescribing at the individual patient level in acute NHS hospitals through infection expert consensus based on the results of a Delphi process.

Antibiotics, Antimicrobial resistance, Antimicrobial stewardship, Days of therapy, Inappropriate prescribing, Start Smart then Focus
1-11
Hood, Graeme
dec86ebd-8a3d-496f-bc81-e7a3ce4483e5
Hand, Kieran S.
5407b07a-7b4b-47e2-b0cf-d662f7d7a3e6
Cramp, Emma
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Howard, Philip
ecd52893-e2a7-4e41-b315-d2b7271a0d4c
Hopkins, Susan
a9f3ef09-c1f1-4020-9423-1c739833f8fb
Ashiru-Oredope, Diane
ca399b9f-8cf1-4b0c-85ac-9d395de53ed3
on behalf of Antibiotic Prescribing Appropriateness Measures (APAM) subgroup of the national Advisory Committee on Antimicrobial Resistance, Prescribing and Healthcare Associated Infection (ARPHAI)
Hood, Graeme
dec86ebd-8a3d-496f-bc81-e7a3ce4483e5
Hand, Kieran S.
5407b07a-7b4b-47e2-b0cf-d662f7d7a3e6
Cramp, Emma
5015f84a-3973-494f-b70d-3a45964871cb
Howard, Philip
ecd52893-e2a7-4e41-b315-d2b7271a0d4c
Hopkins, Susan
a9f3ef09-c1f1-4020-9423-1c739833f8fb
Ashiru-Oredope, Diane
ca399b9f-8cf1-4b0c-85ac-9d395de53ed3

on behalf of Antibiotic Prescribing Appropriateness Measures (APAM) subgroup of the national Advisory Committee on Antimicrobial Resistance, Prescribing and Healthcare Associated Infection (ARPHAI) (2019) Measuring appropriate antibiotic prescribing in acute hospitals: development of a national audit tool through a Delphi consensus. Antibiotics, 8 (2), 1-11, [49]. (doi:10.3390/antibiotics8020049).

Record type: Article

Abstract

This study developed a patient-level audit tool to assess the appropriateness of antibiotic prescribing in acute National Health Service (NHS) hospitals in the UK. A modified Delphi process was used to evaluate variables identified from published literature that could be used to support an assessment of appropriateness of antibiotic use. At a national workshop, 22 infection experts reached a consensus to define appropriate prescribing and agree upon an initial draft audit tool. Following this, a national multidisciplinary panel of 19 infection experts, of whom only one was part of the workshop, was convened to evaluate and validate variables using questionnaires to confirm the relevance of each variable in assessing appropriate prescribing. The initial evidence synthesis of published literature identified 25 variables that could be used to support an assessment of appropriateness of antibiotic use. All the panel members reviewed the variables for the first round of the Delphi; the panel accepted 23 out of 25 variables. Following review by the project team, one of the two rejected variables was rephrased, and the second neutral variable was re-scored. The panel accepted both these variables in round two with a 68% response rate. Accepted variables were used to develop an audit tool to determine the extent of appropriateness of antibiotic prescribing at the individual patient level in acute NHS hospitals through infection expert consensus based on the results of a Delphi process.

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Accepted/In Press date: 23 April 2019
Published date: 1 June 2019
Keywords: Antibiotics, Antimicrobial resistance, Antimicrobial stewardship, Days of therapy, Inappropriate prescribing, Start Smart then Focus

Identifiers

Local EPrints ID: 431981
URI: http://eprints.soton.ac.uk/id/eprint/431981
PURE UUID: e89e0b3f-6e28-42b0-8736-91ab329e1947
ORCID for Kieran S. Hand: ORCID iD orcid.org/0000-0002-3834-2415

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Date deposited: 26 Jun 2019 16:30
Last modified: 07 Oct 2020 02:20

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Contributors

Author: Graeme Hood
Author: Kieran S. Hand ORCID iD
Author: Emma Cramp
Author: Philip Howard
Author: Susan Hopkins
Author: Diane Ashiru-Oredope
Corporate Author: on behalf of Antibiotic Prescribing Appropriateness Measures (APAM) subgroup of the national Advisory Committee on Antimicrobial Resistance, Prescribing and Healthcare Associated Infection (ARPHAI)

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