Nurse Prompting for Prescriber-Led Review of Antimicrobial Use in the Critical Care Unit: A Quality Improvement Intervention with Controlled Interrupted Time Series Analysis.
Bibliographic record
Abstract
Audit-and-feedback (A&F) is a core strategy for antimicrobial stewardship programs (ASPs). However, it is resource-intensive, and may not be practical in every setting. Recent guidelines support the non-ASP-led review of antimicrobials by prescribers (AM-REV) on a routine basis. A sustainable strategy for AM-REV in a critical care unit (CrCU) may improve antimicrobial utilization without additional ASP resources. Using a quality improvement framework, a prompt for AM-REV strategy was created. The primary outcome was antimicrobial utilization defined by days of therapy/1000 patient-days (AM-DOT). A secondary process outcome was the proportion of relevant cases for which an antimicrobial prompt was provided to the prescriber (AM-PRT). Balancing measures included CrCU mortality rates, length of stay, and 48-hours re-admission rates. Utilization data of a control class of medications (proton-pump inhibitors) was also collected. AM-DOT was collected for 34 months pre- and 14 months post-intervention. AM-PRT was collected for 3 months pre- and 12 months post-intervention. Segmented regression analysis was used for the primary outcome, with a descriptive analysis of secondary outcomes. CrCU nurses were recruited to prompt AM-REV during CrCU rounds. A standardized script was developed to insert day of antimicrobial therapy into rounds; prescribers were primed to respond with affirmation, rationale, and clinical decisions. Plan-Do-Study-Act (PDSA) cycles further refined the intervention to include nursing reminders from CrCU pharmacists and increased engagement of nurses during formal A&F rounds. Prior to the intervention, monthly AM-DOT was 804 with a positive trend (7.3 DOT/1000PD, P < 0.05). Post-intervention resulted in an immediate reduction of 217 DOT/1000 PD (P < 0.05) with a non-significant negative AM-DOT trend, representing a 20% (95% CI –15%, -25%) reduction in AM-DOT per month. There was no significant change in utilization of the control class of medications. The ABX-PRT increased from 17% to 50% during the intervention period. Balancing measures were comparable pre and post-intervention. Nurse prompting of AM-REV can lead to significant reductions in antimicrobial utilization, providing a non-ASP mechanism of sustaining antimicrobial awareness. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".