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Table 3 Reported reasons for non-performance of an applicable checklist item

From: The antibiotic checklist: an observational study of the discrepancy between reported and actually performed checklist items

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