Reducing Vancomycin Use in a Level IV NICU.

Area of Science:

• Neonatal Medicine
• Infectious Diseases
• Quality Improvement Science

Background:

• Vancomycin is frequently prescribed in NICUs, often exceeding recommendations for resistant infections.
• High vancomycin use in the study NICU prompted a quality improvement initiative to align with peer institutions.
• The study aimed to decrease vancomycin prescribing in neonates by 50% within one year and maintain the reduction.

Purpose of the Study:

• To reduce the rate of vancomycin prescribing in neonates hospitalized in a NICU.
• To achieve a 50% reduction in vancomycin use within one year.
• To sustain the reduced vancomycin prescribing rate for an additional year.

Main Methods:

• A quality improvement framework was implemented in a 60-bed level IV NICU.
• Interventions included physician education with benchmarking, pharmacy-led 48-hour antibiotic time-outs, and standardized clinical pathways.
• Daily prospective audits with antimicrobial stewardship feedback were conducted.

Main Results:

• Vancomycin use decreased from 112 to 38 days of therapy per 1000 patient-days, a 66% reduction.
• Initial interventions led to a 29% decline, with a further 52% decrease after prospective audit implementation.
• Vancomycin-associated acute kidney injury incidence dropped from 1.4 to 0.1 events per 1000 patient-days.

Conclusions:

• A sequential implementation of education, standardization, time-outs, and audits effectively reduced vancomycin prescribing.
• The 66% reduction in vancomycin days of therapy was achieved and sustained over a two-year period.
• This quality improvement strategy significantly decreased antibiotic use and associated adverse events in the NICU.