Use of the DMAIC Lean Six Sigma quality improvement framework to improve beta-lactam antibiotic adequacy in the critically ill.

Autor:	Wessel RJ; Strategy Department, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States., Rivera CG; Department of Pharmacy, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States., Ausman SE; Department of Pharmacy, Mayo Clinic Health System, 733 W Clairemont Ave, Eau Claire, WI 54701, United States., Martin N; Department of Pharmacy, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States., Braga SA; Department of Pharmacy, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States., Hagy NT; Department of Pharmacy, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States., Moreland-Head LN; Indiana University School of Medicine, 340 West 10th Street, Fairbanks Hall, Suite 6200, Indianapolis, IN 46202, United States., Abu Saleh OM; Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States., Gajic O; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States., Jannetto PJ; Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States., Barreto EF; Department of Pharmacy, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, United States.
Jazyk:	angličtina
Zdroj:	International journal for quality in health care : journal of the International Society for Quality in Health Care [Int J Qual Health Care] 2024 Jul 19; Vol. 36 (3).
DOI:	10.1093/intqhc/mzae062
Abstrakt:	Beta-lactam antibiotics are widely used in the intensive care unit due to their favorable effectiveness and safety profiles. Beta-lactams given to patients with sepsis must be delivered as soon as possible after infection recognition (early), treat the suspected organism (appropriate), and be administered at a dose that eradicates the infection (adequate). Early and appropriate antibiotic delivery occurs in >90% of patients, but less than half of patients with sepsis achieve adequate antibiotic exposure. This project aimed to address this quality gap and improve beta-lactam adequacy using the Define, Measure, Analyze, Improve, and Control Lean Six Sigma quality improvement framework. A multidisciplinary steering committee was formed, which completed a stakeholder analysis to define the gap in practice. An Ishikawa cause and effect (Fishbone) diagram was used to identify the root causes and an impact/effort grid facilitated prioritization of interventions. An intervention that included bundled education with the use of therapeutic drug monitoring (TDM; i.e. drug-level testing) was projected to have the highest impact relative to the amount of effort and selected to address beta-lactam inadequacy in the critically ill. The education and TDM intervention were deployed through a Plan, Do, Study, Act cycle. In the 3 months after "go-live," 54 episodes of beta-lactam TDM occurred in 41 unique intensive care unit patients. The primary quality metric of beta-lactam adequacy was achieved in 94% of individuals after the intervention. Ninety-four percent of clinicians gauged the education provided as sufficient. The primary counterbalance of antimicrobial days of therapy, a core antimicrobial stewardship metric, was unchanged over time (favorable result; P = .73). Application of the Define, Measure, Analyze, Improve, and Control Lean Six Sigma quality improvement framework effectively improved beta-lactam adequacy in critically ill patients. The approach taken in this quality improvement project is widely generalizable to other drugs, drug classes, or settings to increase the adequacy of drug exposure. (© The Author(s) 2024. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.)
Databáze:	MEDLINE
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