Development and validation of an Antibiotic Administration and - - PowerPoint PPT Presentation

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Development and validation of an Antibiotic Administration and Teaching Assessment Tool for evaluation of nurses’ antibiotic stewardship practice.

Chimwemwe Mula(PhD Student) Supervisors: Dr. Lyn Middleton, Prof. Adamson Muula, Mr. Vernon Solomon Mentor: Beate Garcia

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Background

• Antimicrobial resistance is a global problem associated with

misuse, underuse or overuse of antibiotics

• WHO recommend AMS programs.
• Adherence to antibiotic guidelines is associated with

minimizing antimicrobial resistance.

• Current models/guidelines focus on doctors, pharmacists, lab

surveillance and rarely nurses.

Amabile 2010, WHO 2001, CDC, Makoka 2012, Feasey 2015, Edward 2011, Ladeinham, 2013, Dellit 2007, IDSA , SHEA , Olans 2015.

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Overall Study focus

Phase 1. Understanding nurses’ role and challenges in AMS:

• FGD, Observations, Interviews with Drs, pharmacists, lab,

Nurses

• Findings: Nurses multiple roles‐microbiology specimen

management, contributing to prescription decisions, ensuring antibiotic availability at point of care, antibiotic preparation, administration and patient teaching.

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Overall study focus cont.

• Challenges: competency, multidisciplinary team work,

inadequate resources, workarounds

• Recommendations: Training, Guidelines, Communication/

meetings/ collaboration and supervision and monitoring.

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Overall Study focus cont. Phase 2. Developing and piloting:

• training and guideline intervention

However guidelines don’t influence practice so well trained and supervised staff is what we need. Phase 3.

• Developing an antibiotic administration and teaching

assessment tool ( AATAT)

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Phase 3: Main Question

• How can a Nurse ‐ Focused Antibiotic Administration and

Teaching Assessment Tool (AATAT) be developed and validated for evaluation of nurses’ antibiotic stewardship practices?

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Steps in the validation process Hogli et al

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Process of developing the Intervention

Based on international guidelines and local protocols:

• Identified 18 QI items from AMS guidelines and others

recommended by stakeholders

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Process of developing the Intervention

Quality Indicator Item Following assessment and review, check that the physician has documented in the file and treatment chart: 1.Time of antibiotic prescription

• 2. Dose of prescribed antibiotic
• 3. Route of prescribed antibiotic
• 4. Duration of treatment or review/stop date of antibiotic
• 5. Ensure the prescribed antibiotic is available in the emergency department.
• 6. Ensure the prescribed antibiotic is available in the ward
• 7. Microbiology sample should be taken before the first dose of empirical antibiotic treatment is initiated.
• 8. Patient triaged as priority should be given initial intravenous antibiotic treatment within one hour of prescription.
• 9. Patient triaged as urgent and requires resuscitation should be given the initial intravenous antibiotic dose within 30 minutes of prescription.
• 10. Time of initial antibiotic dose administration should be documented in patient file and treatment chart.

Patient/relative should be Educated about antibiotic treatment concerning:

• 11. The indication of the antibiotic treatment.
• 12. Frequency of antibiotic treatment while in hospital with times specified.
• 13. The duration of antibiotic treatment.
• 14. Importance of complying with the antibiotic treatment regimen.
• 15. Subsequent doses should be administered according to prescription following the medication administration standards.
• 16. Patient’s ability to take oral antibiotic (able to swallow, decreased temperature) should be documented.
• 17. Patient should be switched from intravenous to oral antibiotic upon doctor’s order.
• 18. Total duration of antibiotic administration should be according to prescription.

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Face validation by pharmacist:

• The expert made several revisions to the items that resulted

into 25 QIs Content validity‐ expert nurses:

• The QI were reformulated into a questionnaire
• Seven expert nurses performed the content validation and

most criteria were scored 4 or 5(very relevant or very much relevant). AATAT

• Converted into 25 review criteria ( standard and qualifying

statement) forming the AATAT.

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Process of developing the Intervention cont.

Categorised the review criteria into six domains:

• assessment for infection
• verification of physician’s documentation of antibiotic

prescription

• availability of prescribed antibiotics at point of care
• timely antibiotic initiation following culture specimen

collection

• patient education
• daily antibiotic administration (dosing intervals, switch from

intravenous to oral, duration).

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Process of developing the Intervention cont.

Field testing to demonstrate adherence

• 33 pneumonia patients.
• Adherence was 100% for seven criteria: assessment of

temperature; documentation of generic name of antibiotic; documentation of dose, frequency; availability of antibiotics in the ward; administration of the right dose; using the right route.

• Low adherence was identified in patient education.

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Process of developing the Intervention cont

Feasibility

• Mean data collection for rater 1 was 4.6 days (range 1‐9

days).

• Mean application time for rater 1 second time was 3.7

minutes.

• For rater 2 (CM), mean application time was 4.4 minutes.
• Small difference in mean application time for rater 1, 2nd time

and rater 2 indicate that different users of the tool will spend almost similar amount of time if data is already available

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Process of developing the Intervention cont.

Reliability was tested using Kappa statistics for inter‐ and intra‐ rater agreement

• Inter and intra‐rater agreement was high with Kappa‐values
• f 0.78 (95% CI: 0.76, 0.79) and 0.72 (95% CI: 70, 0.75)

respectively demonstrating substantial agreement.

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Knowledge Contribution

• Developed a 25‐criterion assessment tool for evaluating

nurses’ antibiotic stewardship practices in hospitalized adult pneumonia patients prescribed antibiotics.

• Face and content validity and high feasibility demonstrated.
• Even though reliability testing showed substantial agreement

between raters, there is room for improvement.

• Overall adherence to the tool was intermediate, which was

good adherence but areas of improvement were mainly patient education.

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Lessons and Applicability:

• It is feasible to develop and validate and Antibiotic

administration tool for nurses which has a gap in literature.

• Patient education about their antibiotic treatment should be

emphasised and monitored.

• The tool can further be validated and scaled up to be used in
• ur context to monitor and give feedback on nurses’

antibiotic stewardship practices.

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Acknowledgement

This project was funded by NORHED antimicrobial stewardship project; African Doctoral Dissertation Research Fellowship award

• ffered by the African Population and Health Research Centre (

APHRC) in partnership with the International Development Research Centre ( IDRC). UKZN, University of Malawi‐ College of Medicine and Kamuzu College of Nursing

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Thank you Zikomo