Multidisciplinary Initiative to Increase Guideline-concordant Antibiotic Prescription at Discharge for Hospitalized
Alexandra B Yonts1, Laura B O'Neill2, Matthew A Magyar2
1From the Division of Infectious Diseases, Children's National Hospital, Washington, D.C.
Insights
Quality improvement methods significantly increased guideline-concordant antibiotic prescribing for pediatric pneumonia. This sustained improvement in antibiotic stewardship occurred without negative impacts on patient safety outcomes.
Area of Science:
- Pediatrics
- Infectious Diseases
- Quality Improvement Science
Background:
- Clinical guidelines advocate narrow-spectrum antibiotics for uncomplicated pediatric pneumonia.
- This study addresses the need to improve adherence to these antibiotic prescribing guidelines.
Purpose of the Study:
- To assess the effectiveness of quality improvement (QI) interventions in enhancing guideline-concordant antibiotic prescribing for pediatric pneumonia at hospital discharge.
- To evaluate the sustainability of these QI methods over time.
Main Methods:
- A single-center quality improvement project utilized iterative plan-do-study-act cycles.
- Interventions included didactic sessions, visual job aids, and conference presentations for pediatric resident teams.
- Data were collected via chart review, comparing baseline rates with post-intervention periods.
Main Results:
- Baseline guideline-concordant antibiotic prescribing was 67% prior to interventions.
- Following QI interventions, the prescribing rate increased to 87% and was sustained for at least 12 months.
- No significant changes were observed in post-discharge emergency visits, readmissions, or adverse drug reactions.
Conclusions:
- Quality improvement initiatives can effectively and sustainably improve antibiotic prescribing for pediatric pneumonia.
- The implemented interventions demonstrated a lasting positive impact on adherence to clinical guidelines.
- The study highlights the success of QI methods in pediatric antibiotic stewardship without compromising patient safety.
Background:
Clinical practice guidelines recommend using narrow-spectrum antibiotics to treat uncomplicated pneumonia in children. This quality improvement (QI) project aimed to evaluate if QI methods could improve guideline-concordant antibiotic prescribing at hospital discharge for children with uncomplicated pneumonia.
Methods:
For this single-center QI project, we implemented QI interventions in serial plan-do-study-act cycles, focusing on the key drivers targeting general pediatric inpatient resident teams. Interventions included: (1)Small bimonthly group didactic sessions, (2)Visual job aids posted in resident work areas, and (3) A noon conference session. Balancing measures included postdischarge emergency room visits, readmission and adverse drug reactions.
Results:
To establish a baseline rate, we conducted a chart review of 112 children diagnosed with uncomplicated community-acquired pneumonia during hospitalization from July 2017 through January 2019. The average monthly percentage of children discharged with guideline-concordant antibiotics was 67%. The intervention period was from February 2019 through February 2020, with 118 children meeting the criteria after a review of 262 charts. After our interventions, the average monthly percentage of children discharged with guideline-concordant antibiotics increased to 87%, with the increase persisting for at least 12 months. There were no significant differences in balancing measures pre- and post-interventions.
Conclusions:
Our QI initiative sustained increased rates of uncomplicated community-acquired pneumonia guideline-concordant antibiotic prescribing at discharge over 12 months without an increase in balancing measures. The enduring changes in prescribing behavior suggest a lasting impact of our interventions.
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