在社区卫生保健系统中实用地扩展新生儿抗生素管理计划
Julie S Martin1,2, Caleb J Botta2, Sarah Bowman2
1Piedmont Athens Regional, Athens, Georgia.
Pediatrics
|December 14, 2023
概括
一个医疗保健系统成功地减少了多家医院的新生儿抗生素使用,在NICU和新生儿托儿所,每1000个患者日的抗生素日数显著减少. 这一举措显示了持续的改善和婴儿抗生素疗程的减少.
科学领域:
- 新生儿医学 新生儿医学
- 传染性疾病 传染性疾病
- 改善医疗保健质量 改善医疗保健质量
背景情况:
- 以前的新生儿抗生素管理工作主要是基于单一中心的.
- 一个医疗保健系统启动了一项多中心质量改善项目,以减少新生儿重症监护室 (NICU) 和新生儿托儿所 (NBN) 的抗生素使用.
- 该计划持续了4年,涉及整个医疗保健系统的13个NICU和NBN.
研究的目的:
- 实施和评估一个全系统的新生儿抗生素管理计划.
- 在参与医院的NICU和NBN新生儿中,减少10%的抗生素利用率 (AUR).
- 评估干预后减少抗生素使用的可持续性.
主要方法:
- 从2016年到2019年,使用了多中心学习协作框架.
- 计划-做-研究-行动循环指导了变革理念的实施.
- 抗生素利用率 (AUR) 是主要的结果指标,抗生素重新开始作为平衡措施.
主要成果:
- 皮埃蒙特雅典地区实现了NICU AUR减少46%和NBN AUR减少83%.
- 整个皮埃德蒙特医疗保健网络的NICU AUR减少了40%和NBN AUR减少了74%.
- 大多数参与的NICU (7/8) 和NBN (5/7) 实现了10%的AUR减少目标,并观察到持续的改善.
结论:
- 一个全系统的方法有效地减少了新生儿在多家医院的抗生素使用.
- 对于NICU成功的关键驱动因素包括长期参与,多学科团队和高基线AUR.
- 新生儿败血症风险计算器的实施是幼儿园改善的主要驱动因素.
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