title: Audit and Feedback-Focused approach to Evidence-based Care in Treating patients with pneumonia in hospital (AFFECT Study).
abstract: BACKGROUND
  Pneumonia is the eighth leading cause of death in Canada. Use of guideline-concordant therapy tempers the development of resistance, decreases health care costs, and reduces morbidity and mortality.
  
  
  OBJECTIVE
  The purpose of this study was to optimize the treatment of patients with pneumonia under hospitalist care by focusing on best practice and local antibiogram data. The objectives were to collaborate with a hospitalist representative to optimize in-hospital treatment of patients with community-acquired, hospital-acquired, and health care-associated pneumonia; to complete a baseline audit to determine the proportion of antibiotic orders adhering to the strategy; to present the strategy and baseline audit findings to the hospitalists; to perform a post-intervention audit, with comparison to baseline, and to present results to the hospitalists; to expedite de-escalation to a narrower-spectrum antibiotic; to expedite parenteral-to-oral step-down therapy and promote appropriate duration of therapy; and to determine if a pneumonia scoring system was used.
  
  
  METHODS
  An audit and feedback intervention focusing on pre- and post-intervention retrospective chart audits was completed. Review of pneumonia guidelines and the local antibiogram assisted in identifying the study strategy. A presentation to the hospitalists outlined antimicrobial stewardship principles and described the findings of the baseline audit. Pre- and post-intervention audit results were compared.
  
  
  RESULTS
  Local best-practice treatment algorithms were developed for community-acquired pneumonia and for hospital-acquired and health care-associated pneumonia. The pre-intervention audit covered the period December 2011 to January 2012, with subsequent education and audit results presented to the hospitalists in November 2012. The post-intervention audit covered the period December 2012 to January 2013. Adherence to the treatment algorithms increased from 10% (2/21) in the pre-intervention audit to 38% (5/13) in the post-intervention audit. There was a trend to reduced duration of therapy in the post-intervention group.
  
  
  CONCLUSIONS
  An audit and feedback intervention related to hospitalists' prescribing for pneumonia increased adherence to local best practice.
authors.affiliation: , BSP, ACPR, is a PharmD student in the Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia. She completed her pharmacy practice residency with the Regina Qu'Appelle Health Region, Regina, Saskatchewan, in 2012/2013.
authors.forename: Katelyn
authors.initials: K
authors.lastname: Halpape
authors.affiliation: , BSP, PharmD, is with Regina Qu'Appelle Health Region, Regina, Saskatchewan.
authors.forename: Linda
authors.initials: L
authors.lastname: Sulz
authors.affiliation: , BSP, ACPR, PharmD, FCSHP, is with Regina Qu'Appelle Health Region, and the Department of Academic Family Medicine, University of Saskatchewan, Regina, Saskatchewan.
authors.forename: Brenda
authors.initials: B
authors.lastname: Schuster
authors.affiliation: , MD, CCFP(EM), is with Regina Qu'Appelle Health Region, Regina, Saskatchewan.
authors.forename: Ron
authors.initials: R
authors.lastname: Taylor
keywords: antimicrobial stewardship; audit and feedback; pneumonia