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Using Electronic Health Record Tools to Decrease Antibiotic Exposure in Infant Sepsis Evaluation.

Sarah Corey Bauer1,2, Caitlin Kaeppler3,2, Paula Soung3,2

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Summary

Clinical decision support tools reduced prolonged antibiotic use in infants undergoing sepsis evaluation. Documentation of the 36-hour antibiotic discontinuation phrase improved significantly, decreasing unnecessary antibiotic exposure.

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Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Quality Improvement in Healthcare

Background:

  • Infant sepsis evaluations often involve prolonged antibiotic administration, even with negative cultures.
  • Current guidelines recommend antibiotic discontinuation for infants with negative cultures after 36 hours.
  • Optimizing antibiotic duration is crucial to minimize resistance and side effects.

Purpose of the Study:

  • To decrease antibiotic exposure in infants with negative culture results by reducing administration beyond 30 hours.
  • To increase the documentation rate of the 36-hour antibiotic discontinuation phrase in medical records.
  • To implement clinical decision support tools to achieve these aims.

Main Methods:

  • Quality improvement methodology was applied to infants aged 60 days or younger with negative cultures.
  • Outcome measures included percentage of patients receiving >30 hours of antibiotics and 36-hour phrase documentation.
  • Interventions involved education, H&P templates, and smartphrases to promote timely antibiotic discontinuation.

Main Results:

  • The percentage of infants receiving >30 hours of antibiotics decreased from 75.6% to 62%.
  • Documentation of the 36-hour phrase in H&P notes increased from 4.9% to 75.6%.
  • No increase in readmissions for positive cultures was observed.

Conclusions:

  • Clinical decision support and educational interventions effectively promoted the 36-hour phrase documentation.
  • These strategies were associated with reduced antibiotic exposure in infants hospitalized for sepsis evaluation with negative cultures.