- Author
-
F.V. van Daalen
- Title
- Improving antibiotic use in daily hospital practice
- Subtitle
- The antibiotic checklist
- Supervisors
- Co-supervisors
-
J.M. Prins
- Award date
- 11 January 2018
- Number of pages
- 236
- ISBN
- 9789463610353
- Document type
- PhD thesis
- Faculty
- Faculty of Medicine (AMC-UvA)
- Abstract
-
Better use of current antibiotic agents is necessary to help control antimicrobial resistance (AMR). Antibiotic stewardship programs (ASPs) are introduced to coordinate activities to measure and improve appropriate antibiotic use in daily hospital practice. This thesis shows how the introduction of an antibiotic checklist as stewardship intervention involves frontline physicians in the aims of ASP. It is an intervention that can be used in different settings and requires limited resources. Use of the antibiotic checklist in daily hospital practice improved the appropriateness of antibiotic use defined by validated generic quality indicators. Although appropriate antibiotic use was associated with a reduction in length of stay, checklist use did not result in a reduction of length of stay. Non-adherence to the checklist items is the most probable explanation for this lack of effect. This thesis also illustrates that changing human behavior is challenging. When implementing an intervention, physicians’ agreement with the contents of the intervention, a healthcare leader as role model, and a survey to local barriers are crucial components for successful implementation of an intervention. Barrier identification before and during the use of an intervention is strongly recommended for optimization of the effect.
- Persistent Identifier
- https://hdl.handle.net/11245.1/b7b8ce99-a357-4ddb-a254-4bcf601d4cda
- Downloads
-
Thesis (complete)
Front matter
Chapter 1: General introduction and outline of the thesis
Chapter 2: A survey to identify barriers of implementing an antibiotic checklist
Chapter 3: A cluster randomized trial for the implementation of an antibiotic checklist based on validated quality indicators: The AB-checklist
Chapter 4: The effect of an antibiotic checklist on length of hospital stay and appropriate antibiotic use in adult patients treated with intravenous antibiotics: A stepped wedge cluster randomized trial
Chapter 5: The antibiotic checklist: reported- and actually performed checklist items
Chapter 6: The economic evaluation of an antibiotic checklist as antimicrobial stewardship intervention
Chapter 7: Implementation of an antibiotic checklist increased appropriate antibiotic use in the hospital on Aruba
Chapter 8: A healthcare failure mode and effect analysis to optimize all steps in the process of blood culture performance
Chapter 9: Clinical condition and comorbidity as determinants for blood culture positivity in patients with skin and soft tissue infections
Chapter 10: General discussion
Chapter 11: Summary in English
Chapter 12: Summary in Dutch
Addendum
Stellingen
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