ArticlePloS one2018
Development of actionable quality indicators and an action implementation toolbox for appropriate antibiotic use at intensive care units: A modified-RAND Delphi study.
Article in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed.
- Article
- Correct sepsis classification-A must for antimicrobial stewardship: A longitudinal observational study.World journal of critical care medicine · 2025Article
- Comprehensive Evaluation of Quality Indicators: Analyzing the Dutch Breast Cancer Audit.International journal of health policy and management · 2025Article
- Identifying AWaRe indicators for appropriate antibiotic use: a narrative review.The Journal of antimicrobial chemotherapy · 2024Review
- Process, structural, and outcome quality indicators to support perioperative opioid stewardship: a rapid review.Perioperative medicine (London, England) · 2023Article
- Development of Quality Indicators to Evaluate the Appropriateness of Empiric Antimicrobial Use in Pediatric Patients.The Canadian journal of hospital pharmacy · 2023Article
- Development of a quality indicator set to measure and improve quality of ICU care in low- and middle-income countries.Intensive care medicine · 2022Article
- Development of key quality indicators for appropriate antibiotic use in the Republic of Korea: results of a modified Delphi survey.Antimicrobial resistance and infection control · 2021Article
- Organization of antibiotic stewardship in Europe: the way to go.Wiener medizinische Wochenschrift (1946) · 2021Article
- Towards Better Perioperative Pain Management in Mexico: A Study in a Network of Hospitals Using Quality Improvement Methods from PAIN OUT.Journal of pain research · 2021Article
- How to evaluate intensive care unit performance during the COVID-19 pandemic.Revista Brasileira de terapia intensiva · 2020Article
- Inapropriate use of antibiotics effective against gram positive microorganisms despite restrictive antibiotic policies in ICUs: a prospective observational study.BMC infectious diseases · 2020Observational
- Governance of health research funding institutions: an integrated conceptual framework and actionable functions of governance.Health research policy and systems · 2020Article
- Prioritizing suicide prevention guideline recommendations in specialist mental healthcare: a Delphi study.BMC psychiatry · 2020Article
- Development of a quality indicator set to measure and improve quality of ICU care for patients with traumatic brain injury.Critical care (London, England) · 2019Article
- Article
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8 authors.
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Abstract
introductionExtensive antibiotic use makes the intensive care unit (ICU) an important focus for antibiotic stewardship programs. The aim of this study was to develop a set of actionable quality indicators for appropriate antibiotic use at ICUs and an implementation toolbox, which can be used to assess and improve the appropriateness of antibiotic use in the treatment of adult patients at an ICU.
methodsA four round modified-RAND Delphi procedure was used. Potential indicators were identified by a multidisciplinary panel of 15 Dutch experts, from international literature and guidelines. Using an online survey, the identified indicators were rated on three criteria: relevance, actionability and feasibility. Experts discussed and rated the indicators for the second time during a face-to-face consensus meeting. During a final consensus meeting the toolbox was developed, containing potential barriers and improvement strategies which were identified using a validated checklist by Flottorp et al., and if available also containing supporting material.
resultsThe first round resulted in 24 potential indicators. After the final meeting a set of three process indicators, one structure indicator and one quantity metric remained: 1) perform at least two sets of blood cultures before start of empirical systemic therapy; 2) perform therapeutic drug monitoring in patients treated with vancomycin or aminoglycosides; 3) perform surveillance cultures if selective digestive or oropharyngeal decontamination is applied at the ICU; 4) biannual face-to-face meetings between ICU and microbiology staff in which local resistance rates are discussed; and 5) quantitative antibiotic use at the ICU expressed in days of therapy (DOT). The toolbox contains 24 unique barriers and 37 improvement strategies.
conclusionsOur study identified a set of four actionable quality indicators and one quantity metric, together with an implementation toolbox, to improve appropriate antibiotic use at ICUs.
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