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Reduction of Vancomycin Use in a Neonatal Intensive Care Unit: A Quality Improvement Project
Sejal M Bhavsar1,2, Erica B Casella3, Maureen Kim2,4
1From the Division of Pediatric Infectious Diseases, Joseph M. Sanzari Children's Hospital, Hackensack, N.J.
Pediatric Quality & Safety
|May 7, 2025
Summary
This study successfully reduced vancomycin antibiotic utilization in neonatal intensive care units by 37.1%. The quality improvement project safely decreased vancomycin use for late-onset sepsis evaluations without increasing patient morbidity or mortality.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Quality Improvement Science
Background:
- Late-onset sepsis (LOS) is a significant cause of neonatal morbidity and mortality.
- Guidelines recommend against routine empiric vancomycin for neonates without specific risk factors for MRSA.
- Reducing unnecessary vancomycin use is a critical quality improvement goal in Neonatal Intensive Care Units (NICUs).
Purpose of the Study:
- To decrease the mean vancomycin antibiotic utilization rate (AUR) by 30% over 12 months in a level-3 NICU.
- To optimize empiric antibiotic management for suspected late-onset sepsis.
- To ensure the reduction in vancomycin use does not negatively impact patient outcomes.
Main Methods:
- A quality improvement project utilizing the Model for Improvement framework.
- Interventions included provider education, clinical practice guideline (CPG) implementation, and prospective audit with feedback (PAF).
- Data collected on vancomycin AUR, CPG adherence, and patient morbidity/mortality.
Main Results:
- Mean vancomycin AUR decreased by 37.1% (from 27 to 17 days of therapy per 1,000 patient days), sustained postintervention.
- Clinical practice guideline adherence reached 96%.
- No increase in drug-related morbidity or sepsis-related mortality was observed.
Conclusions:
- A quality improvement initiative can achieve a safe, rapid, and sustained reduction in vancomycin use in the NICU.
- Provider education, CPG implementation, and prospective audit with feedback are key components for success.
- Optimizing empiric antibiotic management is feasible and beneficial for neonatal care.
