Quality Metrics for Antimicrobial Stewardship Programs
Michelle Science1,2, Kathryn Timberlake3, Andrew Morris4,5
1Division of Infectious Diseases and michelle.science@sickkids.ca.
Insights
Standard metrics for pediatric antimicrobial stewardship programs (ASPs) were established to optimize antimicrobial use. Four key metrics were agreed upon to improve pediatric ASP outcomes nationally and internationally.
Area of Science:
- Pediatric Infectious Diseases
- Health Services Research
- Quality Improvement
Background:
- Antimicrobial stewardship programs (ASPs) aim to optimize antimicrobial use.
- Established metrics for pediatric ASPs are lacking, hindering outcome assessment.
- This project sought to develop consensus on standard metrics for pediatric ASPs.
Purpose of the Study:
- To identify, refine, and establish consensus on standard outcome metrics for pediatric antimicrobial stewardship programs (ASPs).
Main Methods:
- A modified Delphi process involving 2 surveys and a face-to-face meeting was used.
- Experts and stakeholders ranked metrics based on scientific merit, impact, feasibility, and accountability.
- Metrics with ≥75% agreement were included; those with ≤25% were discarded.
Main Results:
- Consensus was reached on 4 metrics across 4 domains: antimicrobial consumption (days of therapy/1000 patient-days, total antimicrobial days), clinical outcomes (30-day readmission rate), and process measures (adherence to ASP recommendations).
- A microbiologic outcome metric was deemed important but lacked consensus.
- Barriers included information technology limitations.
Conclusions:
- Consensus was achieved on 4 metrics for evaluating pediatric antimicrobial stewardship activities in Canada.
- Adoption of these metrics can facilitate standardized outcome measurement for pediatric ASPs globally.
Background:
Antimicrobial stewardship programs (ASPs) are targeted to optimize antimicrobial use. However, pediatric metrics used to measure outcomes of ASPs are not well established. Our aim for this project was to identify, refine, and develop consensus on standard metrics for pediatric ASPs.
Methods:
By using a modified Delphi process, 2 surveys were sent to experts and stakeholders to establish consensus on the utility of metrics. These were subdivided into 4 ASP domains: (1) antimicrobial consumption, (2) microbiologic outcomes, (3) clinical outcomes, and (4) process measures. Respondents were asked to rank the scientific merit, impact, feasibility, and accountability of each metric. Metrics with ≥75% agreement for scientific merit were included and metrics with ≤25% agreement were discarded. Consensus was finalized with a face-to-face meeting and final survey.
Results:
Thirty-eight participants from 15 pediatric hospitals across Canada completed all 3 rounds of the Delphi survey. In the domain of antimicrobial consumption, the 2 selected metrics were (1) days of therapy per 1000 patient-days and (2) total antimicrobial days. The clinical and process outcomes chosen were (1) 30-day readmission rate and (2) adherence to ASP recommendations, respectively. A microbiologic outcome was felt to be important and feasible, but consensus could not be obtained on a measure. Several barriers to implementation of the metrics were identified, including information technology limitations at various centers.
Conclusions:
We obtained consensus on 4 metrics to evaluate pediatric antimicrobial stewardship activities in Canada. Adoption of these metrics by pediatric ASPs will facilitate measurement of outcomes nationally and internationally.
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