Development of an antimicrobial stewardship intervention using a model of actionable feedback.
We describe the development of an audit and feedback intervention to improve antibiotic prescribing in the neonatal intensive care unit (NICU) using a theoretical framework. Participants included attending physicians, neonatal fellows, pediatric residents, and nurse practitioners. The intervention was based on the "model of actionable feedback" which emphasizes that feedback should be timely, individualized, nonpunitive, and customized to be effective. We found that real-time feedback could not be provided for the parameters established in this study, as we had to collect and analyze numerous data elements to assess appropriate initiation and continuation of antibiotics and required longer intervals to examine trends in antibiotic use. We learned during focus groups that NICU clinicians strongly resisted assigning individual responsibility for antibiotic prescribing as they viewed this as a shared responsibility informed by each patient's laboratory data and clinical course. We were able to create a non-punitive atmosphere thanks to written informed consent from NICU attendings and assurance from leadership that prescribing practices would not be used to assess job performance. We provided customized, meaningful feedback integrating input from the participants. Adapting the principles of the "model of actionable feedback" to provide feedback for antimicrobial prescribing practices proved challenging in the NICU setting. PMID: 22500166 [PubMed]
"This is the closest we're ever going to get to a linkage between what people are eating or drinking and the health of their liver," said the study's senior author.Medscape Medical News
The Red Sox are in a win-or-go-home situation on Friday in Houston. Follow along all night with commentary from Globe reporters.
Problems with executive function and recall are appearing even in younger cohorts. Effects will have significant repercussions on quality of life, work productivity, and healthcare costs, experts warn.Medscape Medical News
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Series Type : Expression profiling by RT-PCROrganism : Homo sapiensThis SuperSeries is composed of the SubSeries listed below.