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Published on: June 11, 2012
Improving intravenous-to-oral antibiotic switch in children: a team-based audit and implementation approach
Brendan Joseph McMullan1,2,3, Michelle Mahony4, Lolita Java5
1Department of Immunology and Infectious Diseases, Sydney Children's Hospital Randwick, Sydney, New South Wales, Australia b.mcmullan@unsw.edu.au.
Insights
A quality improvement program successfully increased timely switching from intravenous to oral antibiotics in hospitalized children. This initiative reduced antibiotic overuse and shortened hospital stays, facilitating faster patient discharge.
Area of Science:
- Pediatric Infectious Diseases
- Hospital Quality Improvement
- Antimicrobial Stewardship
Background:
- Hospitalized children often receive intravenous antibiotics longer than necessary, contributing to overuse and potential complications.
- Optimizing the switch from intravenous to oral antibiotics can reduce in-hospital antibiotic exposure and length of stay.
- Timely antibiotic regimen adjustment is crucial for effective pediatric care and resource management.
Purpose of the Study:
- To implement and evaluate a quality improvement program for timely and safe intravenous-to-oral antibiotic switching in hospitalized children.
- To assess the impact of a guideline-based intervention, including education, audit, and feedback, on antibiotic switch practices.
- To determine the effect of the intervention on key clinical outcomes such as length of stay and readmission rates.
Main Methods:
- A 12-month quality improvement project was conducted in a tertiary pediatric hospital.
- An evidence-based guideline for intravenous-to-oral antibiotic switch was implemented, supported by team-based education and feedback.
- Outcomes included the proportion of eligible children switched within 24 hours, time to switch, hospital length of stay, and readmission rates.
Main Results:
- The percentage of eligible children switched within 24 hours significantly increased from 64% to 82% (p=0.006).
- Median time to switch decreased from 15 hours 42 minutes to 4 hours 20 minutes (p=0.0006).
- A significant 14-hour median reduction in hospital length of stay was observed (p=0.008).
Conclusions:
- The quality improvement approach effectively enhanced the timeliness and safety of intravenous-to-oral antibiotic switching in pediatric patients.
- The intervention led to reduced hospital length of stay, promoting earlier discharge.
- This methodology provides a scalable model for improving antibiotic stewardship in pediatric inpatient settings.
Abstract:
Children in hospital are frequently prescribed intravenous antibiotics for longer than needed. Programmes to optimise timely intravenous-to-oral antibiotic switch may limit excessive in-hospital antibiotic use, minimise complications of intravenous therapy and allow children to go home faster. Here, we describe a quality improvement approach to implement a guideline, with team-based education, audit and feedback, for timely, safe switch from intravenous-to-oral antibiotics in hospitalised children. Eligibility for switch was based on evidence-based guidelines and supported by education and feedback. The project was conducted over 12 months in a tertiary paediatric hospital. Primary outcomes assessed were the proportion of eligible children admitted under paediatric and surgical teams switched within 24 hours, and switch timing prior to and after guideline launch. Secondary outcomes were hospital length of stay, recommencement of intravenous therapy or readmission. The percentage of children switched within 24 hours of eligibility significantly increased from 32/50 (64%) at baseline to 203/249 (82%) post-implementation (p=0.006). The median time to switch fell from 15 hours 42 min to 4 hours 20 min (p=0.0006). In addition, there was a 14-hour median reduction in hospital length of stay (p=0.008). Readmission to hospital and recommencement of intravenous therapy did not significantly change postimplementation. This education, audit and feedback approach improved timely intravenous-to-oral switch in children and also allowed for more timely discharge from hospital. The study demonstrates proof of concept for this implementation with a methodology that can be readily adapted to other paediatric inpatient settings.
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