Designing and implementing a CAP intervention
6.3. Designing and implementing a CAP intervention
A multidisciplinary team should oversee the design and implementation of the intervention. The team will need to include representation from local opin- ion leaders and all the major stakeholders (including patients), and may need to include persons with specific expertise, such as in behavioural psychology and statistics. Prior to deciding on which interventions are to be used and how they are to be implemented, the potential impact and costs of each component of any complex intervention and how these components interrelate should be under- stood. This can be achieved by review of the literature, modelling (e.g., of the economic costs), and small qualitative and/or quantitative studies, as described above. Ideally, components that appear likely to succeed at reasonable cost should then be tested in small intervention studies to establish, for example, the incremental effectiveness of each component, actual costs, and appropriate con- trol groups (MRC framework for the development and evaluation of RCTs for complex interventions to improve health; www.mrc.ac.uk). The latter is unlikely to be feasible, however, for routine QI or small research projects.
In TAYCAPP, the results of the described quantitative and qualitative studies suggested that multiple and complex barriers to any new intervention were
Pneumonia Guidelines in Practice
57 likely to exist and that a multifaceted intervention would be most likely to
succeed. For example, we recognised that an educational programme targeting the link between severity assessment and antibiotic therapy may well improve clinicians’ knowledge. However, the qualitative interviews identified the pres- ence of a potentially negative attitude towards CAP, in that it is considered less important than some other acute medical problems. For example:
I guess the same for myocardial infarction, we can do a lot for it and minutes mean muscle to coin a phrase, whereas in pneumonia it’s just pneumonia … It’s the attitude to it that I see. (Verbatim text from an in-depth interview)
We recognised that potentially this attitudinal barrier could prevent a change in physician behaviour and thereby process of care, even if knowledge did improve. We therefore attempted to upgrade the importance of CAP by empha- sising the high mortality and morbidity and marketing a “door to needle time” ethos in all aspects of the programme. The use of a multifaceted approach was supported by a previously published systematic review that found that multi- faceted interventions (i.e., two or more of audit and feedback, reminders, a local consensus process, and marketing) and interactive educational meetings ( participation of healthcare providers in workshops that include discussion or practice) were more consistently effective in promoting behaviour change in healthcare professionals than, for example, single interventions, such as paper-based educational materials (Bero et al., 1998). In light of the literature review and emerging local evidence, interventions, and implementation strate- gies subsequently included: (1) strategically sited management pathways based on the BTS recommendations and adapted to local practice, (2) posters marketing the BTS severity assessment criteria and a “door to needle time” ethos, (3) dissemination of implementation packs, which contained an expla- nation of the programme, a pocket-sized laminated management algorithm and an interactive educational workbook focusing on the link between severity assessment and appropriate therapy, (4) interactive educational meetings emphasising the severity assessment–appropriate antibiotic therapy link, and (5) continuous audit and monthly feedback.
Parts
» Antibiotic Policies: Theory and Practice
» THEORIES OF FACILITATING CHANGE
» OTHER APPROACHES TO GUIDELINE DEVELOPMENT
» QUALITY ASSURANCE AND DEVELOPMENT OF STANDARDS
» DEVELOPMENT OF CLINICAL STANDARDS IN SCOTLAND
» WHICH QI INTERVENTIONS HAVE BEEN STUDIED IN CAP?
» LINKING PROCESS OF CARE TO OUTCOMES IN QI
» WHAT IS THE EVIDENCE THAT QI INITIATIVES IMPROVE PROCESS OF CARE IN CAP?
» WHAT IS THE EVIDENCE THAT QI INITIATIVES IMPROVE OUTCOMES IN CAP?
» Designing and implementing a CAP intervention
» LEVEL OF AGGREGATION OF ANTIMICROBIALS
» ANTIMICROBIAL USAGE MEASURES
» Relationships based on patient-specific data
» Relationships based on aggregate usage
» ANTIBIOTIC CONSUMPTION; ALTERNATIVE UNITS OF MEASUREMENT
» ANTIBIOTIC CONSUMPTION CALCULATOR
» BENCHMARKING FOR REDUCING VANCOMYCIN USE AND VANCOMYCIN- RESISTANT ENTEROCOCCI IN US ICU S
» THE HARVARD EMERGENCY DEPARTMENT QUALITY STUDY
» ANALYSIS BY INDIVIDUAL ANTIMICROBIAL AGENT
» BENCHMARKING WITH OTHER ANTIMICROBIAL UTILISATION DATA
» STATE OF THE ART OF ANTIBIOTIC PROPHYLAXIS IN SURGERY
» AUDITING AND IMPROVING THE QUALITY OF ANTIBIOTIC PROPHYLAXIS IN SURGERY
» TYPES OF STUDIES TO OBTAIN QUALITY DATA ON A PATIENT LEVEL
» MULTIDISCIPLINARY ANTIMICROBIAL MANAGEMENT TEAMS
» THE ROLE OF THE PHARMACIST IN INFECTION MANAGEMENT
» TRAINING AND SUPPORT IN INFECTION MANAGEMENT FOR PHARMACISTS
» ANTIBIOTIC POLICY IN THE TERTIARY CARE CENTRE
» ANTIBIOTIC CONSUMPTION IN ICU S
» ANTIBIOTIC RESISTANCE IN ICU
» The impact of antibiotic policies and antibiotic consumption on antibiotic resistance
» IT and benchmarking to improve antibiotic prescribing
» COST OF HOSPITAL-ACQUIRED INFECTION
» THE COST OF ANTIMICROBIAL RESISTANCE
» Costs of screening/surveillance cultures
» Isolation, cohorting, and contact isolation
» EPIDEMIOLOGY OF INVASIVE FUNGAL INFECTIONS
» Antifungal resistance in Candida species
» Antifungal resistance cannot be transmitted by extrachromosomal DNA
» RATIONAL USE OF ANTIFUNGAL AGENTS
» THE CHANGING FACE OF VIRAL INFECTIONS AND THEIR MANAGEMENT
» PROBLEMS ASSOCIATED WITH ANTIVIRAL THERAPY
» ANTIVIRAL TREATMENT STRATEGIES
» ANTIVIRAL PROPHYLAXIS STRATEGIES
» ANTIBIOTIC CONCENTRATIONS AT TARGET SITES
» An infant with aplastic anaemia
» A long-standing E. coli infection of liver cysts
» BREAKPOINTS: A SHORT HISTORY AND OVERVIEW
» PHARMACODYNAMIC RELATIONSHIPS AND EMERGENCE OF RESISTANCE
» EVALUATION OF THE ANTIMICROBIAL RESISTANCE SURVEILLANCE DATA PUBLISHED IN THE MEDICAL LITERATURE
» PRACTICAL ASPECTS OF THE IMPLEMENTATION OF THE SURVEILLANCE PROGRAM
» Multivariate analysis methods
» Evolutionary genetic approaches
» Study of the relationship between bacterial resistance and antimicrobial consumption
» To predict the short-term evolution of resistance
» To evaluate interventions to control antibiotic resistance
» DISINFECTANTS: TYPES, ACTIONS, AND USAGES
» Evidence of bacterial resistance to biocides
» Mechanisms of bacterial resistance to biocides
» EVIDENCE OF CROSS-RESISTANCE BETWEEN BIOCIDES AND ANTIBIOTICS
» DISINFECTANT USAGE AND ANTIBIOTIC RESISTANCE
» METHODS OF LITERATURE REVIEW
» PROBLEMS WITH INTERPRETATION OF PUBLISHED STUDIES
» Distribution of educational materials
» Audit and feedback with or without other educational materials
» Educational group meetings or seminars
» Educational outreach/academic detailing
» Financial/healthcare system changes
» EFFECT OF INTERVENTIONS ON ANTIBIOTIC RESISTANCE
» DDD/1,000 INHABITANTS AND DAY (DID)
» PRESCRIPTIONS/1,000 INHABITANTS AND YEAR
» INDICATIONS FOR ANTIBIOTIC PRESCRIPTIONS
» POSSIBLE CAUSES FOR OBSERVED VARIATIONS IN ANTIBIOTIC USE
» DETERMINANTS OF ANTIBIOTIC CONSUMPTION
» COLLECTIVE AWAKENING AND PROGRESSIVE MOBILIZATION OF FRENCH PUBLIC HEALTH AUTHORITIES
» ANTIBIOTIC USE AND COST TRENDS
» IMPACT ON HEALTH BUDGETS OF ANTIBIOTIC USE
» ACCESS TO ESSENTIAL ANTIBIOTICS AT ALL LEVELS OF CARE
» EPIDEMIOLOGY OF ANTIMICROBIAL RESISTANCE
» THREAT OF ANTIMICROBIAL RESISTANCE
» ECONOMIC IMPLICATIONS OF ANTIMICROBIAL RESISTANCE
» FACTORS CONTRIBUTING TO DEVELOPMENT AND SPREAD OF RESISTANCE
» STRATEGIES FOR CONTAINMENT OF RESISTANCE IN DEVELOPING COUNTRIES
» Antibacterial resistance and policies
» Policies, guidelines, and education on antibacterial use
» Discovery, development, and commercialization in the face of policies
» Antibacterial development, labelling, and benefits
» WHAT CAN BE DONE NOW ABOUT ANTIBIOTIC RESISTANCE?
» HOW CAN THE DIAGNOSTIC LABORATORY HELP?
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