Research Article

Development of an Antimicrobial Stewardship Intervention Using a Model of Actionable Feedback

Table 2

Components of actionable feedback for antibiotic prescribing in the NICU.

Process measuresChallengesKey actionsOutcomesAchieved

TimelyProlonged data collection for prescribing practices.
Limited opportunities to present data to group.
Inclusion of rare outcomes.
Partially automated data analysis. Developed templates for data presentations coordinated with NICU leadership and presented data at existing meetings, for example, Morbidity and Mortality Conference emailed data to NICU prescribers prior to presentation.After a one-month interval required to collect and analyze the data, a two-month audit of antibiotic prescribing was presented. This presentation was repeated every 2 months.Partially

IndividualizedRotating “on-service” neonatologists with different duration of service time.
Difficulty and resistance to assigning individual responsibility for specific antimicrobial usage.
Conducted focus groups with prescribers to evaluate acceptance of individual feedback.Feedback indicated that group feedback is desired. Group feedback is provided.
Deidentified examples of antibiotic use discussed.
No

NonpunitiveConcern that results of audit would be shared with peers or used by supervisors to appraise performance.Obtained written informed consent from neonatologists.
Obtained certificate of confidentiality from National Institute for Nursing Research.
98% of eligible physicians enrolled and signed consent.Yes

CustomizedUnique patient population with limited published guidelines for appropriate antimicrobial prescribing.
Different prescribing preferences among subspecialty physicians providing guidance for treatment.
Performed ethnographic studies of work flow and antibiotic decision-making using semi-structured interviews and direct observation [8].
Performed multi-center retrospective study to understand patterns of antibiotic inappropriate antimicrobial use [9].
Conducted surveys using clinical vignettes to assess prescribing preferences [10].
Conducted focus groups with prescribers to identify preferences for types of feedback.
Feedback content reflected preferences of prescribers as well as study team.
Interdisciplinary committee formed to review evidence and formulate recommendations for perioperative antibiotic prophylaxis for cardiac surgery.
Yes

NICU, neonatal intensive care unit.