Assessment of Guideline Concordant Antibiotic Prescribing for Patients with Community Acquired Pneumonia at The Kenyatta National Hospital Medical Wards

Citation:
PN R, GO O, O AE, L A, J K. "Assessment of Guideline Concordant Antibiotic Prescribing for Patients with Community Acquired Pneumonia at The Kenyatta National Hospital Medical Wards." Journal of Kenya Association of Physicians. 2022;5(1):34-42.

Abstract:

Background: Pneumonia is a major cause of morbidity
and mortality globally. Despite the proven benefits of
guideline concordant antibiotic prescribing, research
has shown that adherence to clinical guideline
recommendations is dismal.
Objectives: The study aims to determine utilization of
Kenyatta National Hospital antibiotic guideline titled
‘The KNH guide to empiric antimicrobial therapy
2018’ in the management of community acquired
pneumonia in the Kenyatta National Hospital medical
wards and the perceived barriers towards the utilization
of this guideline.
Materials and methods: A check list derived from the
Kenyatta National Hospital (KNH) guide to empiric
antimicrobial therapy 2018 was used to assess guideline
concordance based on seven quality indicators:
empiric antibiotic, dose and route of administration,
switch to oral antibiotics, duration of antibiotics (at
least 5 days), collection of microbiological samples
before initiating antibiotics, review of antibiotics at 48
hours and once the culture results are out. Online selfadministered questionnaires were used to determine
attitude and perceived barriers towards utilization
of the KNH guideline among the Internal Medicine
registrars and medical officers.
Analysis: Descriptive statistics were applied in
the representation of each of the seven quality
indicators. These were then compared with the
guideline recommendations and adherence to the
guideline for each parameter was expressed as a
percentage of the total number of patients admitted
with community acquired pneumonia. These were
then graded into the following categories based on the
level of concordance: Good >90%, Intermediate 60-
90%, poor <60%. Questions on the attitude and the
perceived barriers towards KNH guideline utilization
were answered using a 5 point Likert scale. Perceived
barrier statements that were positively formulated
were then recorded so that a lower score meant a
lower level of the perceived barriers and vice versa.
Percentages were then calculated for the total number
of doctors that agreed or strongly agreed that the
barrier was applicable. An open ended question on the
top three barriers to the KNH guideline utilization was
also included in the questionnaire.
Results: For each of the other quality indicators,
adherence to the KNH guideline for patients with
community acquired pneumonia was as follows:
empiric antibiotic choice 48%, collection of samples
for culture prior to antibiotic administration 0%, review
of antibiotics at 48 hours 26.4%, review of antibiotics
with culture results 45.8%, total duration of antibiotics
28.8% and time to switch to oral antibiotics 3.6%. The
top three barriers towards guideline utilization among
the doctors were: unavailability of drugs (52.7%),
inaccessibility of the KNH guideline (45.1%) and lack
of or delay of investigations (34.1%).
Conclusion: This study has demonstrated that the level
of adherence to the seven quality indicators from the
KNH guide is poor with the overall adherence being
35.5%. The recommendation least adhered to was
collection of microbiological samples before initiation
of empiric antibiotics. The most commonly identified
barriers to utilization of the guideline were external
and guideline related barriers.
Key words: Guide to empiric antimicrobial therapy
2018, Guideline Concordance antibiotic prescribing,
Community acquired pneumonia

UoN Websites Search