Development of key quality indicators for appropriate antibiotic use in the Republic of Korea: results of a modified Delphi survey

Abstract

Background An effective antibiotic stewardship program relies on the measurement of appropriate antibiotic use, on which there is a lack of consensus. We aimed to develop a set of key quality indicators (QIs) for nationwide point surveillance in the Republic of Korea. Methods A systematic literature search of PubMed, EMBASE, and Cochrane Library (publications until 20th November 2019) was conducted. Potential key QIs were retrieved from the search and then evaluated by a multidisciplinary expert panel using a RAND-modified Delphi procedure comprising two online surveys and a face-to-face meeting. Results The 23 potential key QIs identified from 21 studies were submitted to 25 multidisciplinary expert panels, and 17 key QIs were retained, with a high level of agreement (13 QIs for inpatients, 7 for outpatients, and 3 for surgical prophylaxis). After adding up the importance score and applicability, six key QIs [6 QIs (Q 1–6) for inpatients and 3 (Q 1, 2, and 5) for outpatients] were selected. (1) Prescribe empirical antibiotic therapy according to guideline, (2) change empirical antibiotics to pathogen-directed therapy, (3) obtain culture samples from suspected infection sites, (4) obtain two blood cultures, (5) adapt antibiotic dosage to renal function, and (6) document antibiotic plan. In surgical prophylaxis, the QIs to prescribe antibiotics according to the guideline and initiate antibiotic therapy 1 h before incision were selected. Conclusions We identified key QIs to measure the appropriateness of antibiotic therapy to identify targets for improvement and to evaluate the effects of antibiotic stewardship intervention.

Developing a framework for regular and sustainable qualitative assessment of antibiotic use in Korean medical institutions: a Delphi study

“…This approach overcame the challenge of assessing many quality indicators with other point surveillance methods [ 2 ]. It was agreed that specific quality indicators should be used for assessment, which cannot rely solely on expert judgement, and continuous updates are necessary [ 18 ].…”

Quantitative and qualitative evaluation of antimicrobial usage: the first step for antimicrobial stewardship

“…In Korea, in 2019, a systematic review and consensus among 25 ASP experts led to the publication of 13 indicators for inpatients, 7 for outpatients, and 5 for surgical prophylactic antibiotics. These standardized metrics derived from a systematic evaluation and expert consensus are useful for the assessment of antimicrobial prescription quality [ 45 ] ( Table 5 ).…”

“… The indicators can be used for cross-sectional surveys. Adapted from Kim et al [ 45 ] and Park et al [ 61 ]. …”

Current Status and Prospect of Qualitative Assessment of Antibiotics Prescriptions

“…Further, the European Driving Reinvestment in Research and Development and Responsible Antibiotic Use (DRIVE-AB) project developed 51 quality indicators for inpatients, 34 for outpatients, and 22 for emergency department patients [ 21 22 23 ]. In Korea, in 2019, through the consensus of 25 experts on antibiotics use, 13 quality indicators for inpatients, 7 for outpatients, and 5 for surgical antibiotics prophylaxis were suggested ( Table 1 )[ 24 ]. In Australia, a national antibiotics prescription survey is conducted every year.…”