In 2004 Queensland (QLD) hospitals, public or private, with an Emergency Department, were deemed eligible and were invited to participate. Nine hospitals in QLD agreed. Approval from the Institutional Human Research Ethics Committees was sought where necessary, with some Committees requesting full ethical review.
The project employed established drug use evaluation (DUE) methodology, [12, 13] previously successfully implemented across a number of other hospital projects by the QLD DUE group, NSW Therapeutic Advisory Group and the Victorian DUE Group previously. The CAPTION project involved data collection, and evaluation using the TGAB (12th Ed) as the benchmark, feedback of evaluated data and targeted educational interventions. A baseline audit followed by two complete DUE cycles were implemented during the course of the 2-year project [12, 13].
Each cycle involved the collection of data on 20 consecutive patients who presented to the ED with a provisional diagnosis of community-acquired pneumonia and were prescribed antibiotics while in the ED. Inclusion criteria were that the patient must be at least 18 years of age, and have a diagnosis of CAP documented in the medical record by ED doctors. It was assumed that the choice of empirical antibiotics was based on this diagnosis, and it was not judged whether the initial diagnosis was in fact correct.
Patients were excluded if they were less than 18 years of age; immunosuppressed; had cystic fibrosis; bronchiectasis; tuberculosis; aspiration or hospital acquired pneumonia; or had been discharged from hospital in the previous 14 days or transferred from another hospital.
This baseline data collection was followed by the implementation of a suite of interventions including academic detailing; provision of wall posters and PSI cards (to be attached to the identification (ID) badge) and group feedback presentations on results of the audit. This was followed by another period of data collection (audit two) and a second intervention and a final (third) audit.
Academic detailing training was provided to at least one person in each hospital. This person was nominated by the hospital, to provide the one-on-one education in that hospital. Training consisted of attendance at a two-day workshop, prior to the implementation of education, where the principles of social marketing were explained, and the opportunity provided to partake in role plays using these skills, with medical personnel from local emergency departments.
As each hospital completed data collection, the data (de-identified for patients) were sent to the QLD Project Coordinator and analysis conducted (de-identified for hospital). The proportion of patients for whom a PSI calculation had been recorded and the proportion of patients whose treatment was in concordance with the TGAB were determined using the Auditmaker® program, programmed with the TGAB CAP management algorithm.
The implementation of the project was evaluated using feedback forms (Additional files 1 and 2) after each phase of the project (audit or intervention). Information collected included: duration of data collection period, number of records reviewed, ease of collection, time taken, and number of people educated, educational tools used and problems encountered during the education. Data was summarised by the state coordinator looking for themes. At the completion of the project a group meeting was held with the hospital coordinators during which positive and negative elements of the project were identified by individual hospitals using a presentation template, and general discussion of other benefits or drawbacks held.
The CAPTION project as a whole aimed to:
Evaluate current practice with regards to management of CAP in Emergency Departments
Introduce and implement the CAP management guidelines (TGAB 12th Ed) into the emergency department
Influence and improve the prescribing practice in the management of CAP in the emergency department
Train hospital health care professionals in appropriate techniques for influencing and improving prescribing practice