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Development of Quality Indicators to Evaluate the Appropriateness of Empiric Antimicrobial Use in Pediatric Patients
Holly MacKinnon1, Kathryn Slayter2, Jeannette L Comeau3
1, BScPharm, was, at the time of this study, with Dalhousie University and IWK Health, Halifax, Nova Scotia. She has now graduated and works with Lawtons Drugs.
Insights
Consensus was reached on 28 quality indicators for appropriate empiric antimicrobial use in pediatric inpatients. These indicators help assess antimicrobial prescribing quality and adherence to best practices.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial stewardship
- Health services research
Background:
- Assessing antimicrobial prescribing in pediatric inpatients is crucial.
- Quality indicators are recommended for evaluating antimicrobial use.
- Appropriate antimicrobial prescribing impacts patient outcomes and resistance.
Purpose of the Study:
- To achieve consensus among infectious diseases clinicians on quality indicators.
- To define indicators for appropriate empiric antimicrobial use in pediatric inpatients.
- To establish a benchmark for assessing antimicrobial stewardship.
Main Methods:
- The Delphi technique was employed to reach expert consensus.
- An initial list of quality indicators was developed from a literature search.
- A multidisciplinary panel of experts rated indicators using a 9-point Likert scale.
Main Results:
- Consensus was achieved on 28 of 31 proposed quality indicators after three rounds.
- Indicators were categorized into empiric choice, dose, duration, administration, diagnosis, and documentation.
- Twelve experts completed the survey, with 10 finishing all rounds.
Conclusions:
- Consensus-based quality indicators were established for empiric antimicrobial use in pediatric patients.
- These indicators can be utilized by clinicians and researchers to evaluate prescribing practices.
- The developed indicators support adherence to best practices in pediatric antimicrobial stewardship.
Background:
Use of quality indicators is one strategy recommended to assess antimicrobial prescribing for pediatric inpatients.
Objective:
To achieve consensus from infectious diseases clinicians on quality indicators that characterize appropriate empiric antimicrobial use for the management of infectious syndromes in pediatric inpatients.
Methods:
This study was completed using the Delphi technique. The research team developed an initial list of quality indicators, informed by a literature search. A multidisciplinary group of health care providers with expertise in infectious diseases was invited to participate. The list was disseminated to this panel of experts using Opinio survey software. The experts were asked to rate the indicators on a 9-point Likert scale in relation to the following criterion: "The importance of each item in determining appropriateness considering benefit or harm at the individual or population level". Consensus was defined as at least 75% agreement and a median score of 7 or higher.
Results:
Twelve of 31 invited experts completed at least 1 round of the survey, and 10 completed all rounds. Consensus was achieved on 28 of 31 proposed indicators after 3 rounds. Indicators with consensus were categorized under "empiric choice" (n = 12 indicators), "dose" (n = 5), "duration" (n = 2), "administration" (n = 4), "diagnosis" (n = 2), and "documentation" (n = 3). Six of the indicators for which consensus was achieved were rephrased by the experts.
Conclusions:
Consensus was achieved on quality indicators to assess the appropriateness of empiric antimicrobial use in pediatric patients. Clinicians and researchers can use these consensus-based indicators to assess adherence to best practice.
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