Table 3 Reported reasons for non-performance of an applicable checklist item
Checklist item | Given argument by the physician who completed the checklist for non-performance of the checklist item | Number |
|---|---|---|
Take at least two sets of blood cultures before starting systemic antibiotic therapy | In my opinion, blood culturesare not necessary with this diagnosis | 84 |
Only one set performed instead of two (without explanation) | 45 | |
No indication for blood culture performance because the patient has no fever | 25 | |
Unclear why blood cultures are not performed by my colleague | 24 | |
Only one set performed at the emergency department | 10 | |
No reason given | 10 | |
Only one set performed because phlebotomy was difficult | 7 | |
No indication for blood culture performance because the antibiotics are prophylactic | 6 | |
No indication for blood culture performance because antibiotic treatment is based on previous culture result >1 week ago | 4 | |
We only perform cultures from suspected site of infection | 3 | |
No time to perform blood cultures because of critical clinical condition of the patient | 2 | |
Other | 8 | |
Total | 228 | |
Take specimens for cultures from suspected sites of infection | No culture possible from suspected site of infection | 79 |
No sputum production with a suspected respiratory tract infection | 19 | |
Not done (without explanation) | 5 | |
Culture performance will follow later | 4 | |
Forgotten to perform cultures from suspected site of infection before start of therapy | 3 | |
No reason given | 3 | |
Other | 5 | |
Total | 118 | |
Prescribe systemic antibiotic treatment according to the local antibiotic guideline | No reason given | 22 |
Following other guidelines | 7 | |
Several possible diagnoses: it is notclear which guideline should be followed | 5 | |
We deviate fromlocal guidelines after consulting microbiologist | 4 | |
Antibiotic treatment is based on previous antibiotic therapy | 4 | |
We deviate fromlocal guidelines because mysupervisor prefers another antibiotic | 3 | |
Gentamycin should be given according to the local guidelines,however we did not prescribe gentamycin since the patient is not septic | 2 | |
Other | 11 | |
Total | 58 | |
Adapt dose and dosing interval of systemic antibiotics to renal function | This quality indicator is not applicable to this patient | 38 |
No reason given | 3 | |
Peritoneal dialysis | 1 | |
eGFR just below normal: expectation that renal function will improve quickly | 1 | |
Renal function not known | 1 | |
Total | 44 | |
Document the indicationfor the antibiotictreatment in the case notes or electronic medical record (EMR) | No reason given | 1 |
Fever of unknown origin, and thus we do not know what to document | 1 | |
Cefuroxime is started at the emergency department but the indication is not clearly explained | 1 | |
Total | 3 | |
Adapt therapy when culture results become available | No culture result (yet) | 46 |
No reason given | 18 | |
Pathogen is susceptible to the current antibiotic treatment | 15 | |
Treatment based on clinical condition | 9 | |
Several pathogens are cultured: doubts about relevance | 4 | |
Treatment was already started based on culture results | 3 | |
Treatment chosen after consulting microbiologist | 2 | |
Other | 8 | |
Total | 105 | |
Switch from intravenous to oral antibiotic therapy after 48–72 h | Insufficient clinical improvement | 32 |
No oral antibiotic available | 16 | |
No oral therapy possible with this diagnosis | 14 | |
Antibiotic treatment is stopped | 8 | |
Continue IV (without explanation) | 7 | |
Prefer to treat five days intravenously | 5 | |
No adequate oral intake/gastrointestinal absorption | 3 | |
No reason given | 4 | |
Unclear diagnosis and unclear to which antibiotic should be switched | 3 | |
No culture results | 3 | |
After consulting microbiologist | 2 | |
Allergy | 1 | |
Total | 98 | |
Total | 654 | |