Reducing antibiotic utilization rate in preterm infants: a quality improvement initiative
Background Judicious use of antibiotic therapy in preterm infants is necessary as prolonged and unwarranted use of antibiotics have been associated with adverse short-term and long-term outcomes. Local problem Our baseline data review revealed overuse and unnecessary prolonged antibiotic exposure am...
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| Veröffentlicht in: | Journal of perinatology 2018-04, Vol.38 (4), p.421-429 |
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| creator | Bhat, Ramachandra Custodio, Haidee McCurley, Cathy Whitehurst, Richard Gulati, Rashmi Jha, Om Prakash Bhat, Jayalakshmi Estrada, Benjamin Hill, Amy Eyal, Fabien Zayek, Michael |
| description | Background
Judicious use of antibiotic therapy in preterm infants is necessary as prolonged and unwarranted use of antibiotics have been associated with adverse short-term and long-term outcomes.
Local problem
Our baseline data review revealed overuse and unnecessary prolonged antibiotic exposure among preterm infants despite a low suspicion for sepsis.
Methods and interventions
The baseline overall AUR was calculated retrospectively from our pharmacy database for a period of 4 months prior to the quality improvement (QI) initiative (pre-QI phase). The principal QI intervention included the development and implementation of guidance algorithms for evaluation and management of suspected sepsis incorporating key QI measures, such as an emphasis on early discontinuation of antibiotics by 36 h if blood culture remained negative and the introduction of multiplex polymerase chain reaction assay for early identification of causative organisms. This QI initiative was implemented through multiple Plan-Do-Study-Act cycles, starting in February 2016 (QI phase), with an objective to achieve a 10% reduction in the baseline overall AUR by December 2016, in preterm infants with gestational ages between 25
0/7
and 33
6/7
weeks. Data for the QI phase of the study were collected prospectively.
Result
The overall AUR (outcome measure) decreased from 154.8 to 138.4 days of treatment per 1000 hospital days (10.6% decrease,
p
|
| doi_str_mv | 10.1038/s41372-018-0041-y |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1993996817</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1993996817</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-a44223412f84334b4abdb7f6a7f68b9c61cfc65a887109c2ff9663cf928aff173</originalsourceid><addsrcrecordid>eNp1kEtLAzEUhYMotlZ_gBsZcONmNK_JJO6k-AJBEF24Cpk0KSnzaJNMYfz1prYqCC5CAuc7954cAE4RvESQ8KtAESlxDhHPIaQoH_bAGNGS5UVByT4Yw5KSnBPKRuAohAWEG7E8BCMsiGAFQmPw_mJmvXbtPFNtdJXrotNZH13tPlR0XZt5FU3m2mzpTTS-SU-byHCdqWzVq9rFIXPN0ndr05g2JtlFl5xrcwwOrKqDOdndE_B2d_s6fcifnu8fpzdPuU7ZY64oxZhQhC2nhNCKqmpWlZapdHglNEPaalYozksEhcbWCsaItgJzZS0qyQRcbOemEKvehCgbF7Spa9Warg8SifRZwfgXev4HXXS9b1M6iSERuBAFI4lCW0r7LgRvrFx61yg_SATlpne57V2m3uWmdzkkz9lucl81Zvbj-C46AXgLhCS1c-N_V_8_9ROipY71</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2039259563</pqid></control><display><type>article</type><title>Reducing antibiotic utilization rate in preterm infants: a quality improvement initiative</title><source>Springer Nature - Complete Springer Journals</source><creator>Bhat, Ramachandra ; Custodio, Haidee ; McCurley, Cathy ; Whitehurst, Richard ; Gulati, Rashmi ; Jha, Om Prakash ; Bhat, Jayalakshmi ; Estrada, Benjamin ; Hill, Amy ; Eyal, Fabien ; Zayek, Michael</creator><creatorcontrib>Bhat, Ramachandra ; Custodio, Haidee ; McCurley, Cathy ; Whitehurst, Richard ; Gulati, Rashmi ; Jha, Om Prakash ; Bhat, Jayalakshmi ; Estrada, Benjamin ; Hill, Amy ; Eyal, Fabien ; Zayek, Michael</creatorcontrib><description>Background
Judicious use of antibiotic therapy in preterm infants is necessary as prolonged and unwarranted use of antibiotics have been associated with adverse short-term and long-term outcomes.
Local problem
Our baseline data review revealed overuse and unnecessary prolonged antibiotic exposure among preterm infants despite a low suspicion for sepsis.
Methods and interventions
The baseline overall AUR was calculated retrospectively from our pharmacy database for a period of 4 months prior to the quality improvement (QI) initiative (pre-QI phase). The principal QI intervention included the development and implementation of guidance algorithms for evaluation and management of suspected sepsis incorporating key QI measures, such as an emphasis on early discontinuation of antibiotics by 36 h if blood culture remained negative and the introduction of multiplex polymerase chain reaction assay for early identification of causative organisms. This QI initiative was implemented through multiple Plan-Do-Study-Act cycles, starting in February 2016 (QI phase), with an objective to achieve a 10% reduction in the baseline overall AUR by December 2016, in preterm infants with gestational ages between 25
0/7
and 33
6/7
weeks. Data for the QI phase of the study were collected prospectively.
Result
The overall AUR (outcome measure) decreased from 154.8 to 138.4 days of treatment per 1000 hospital days (10.6% decrease,
p
< 0.05) over the 11-month period. However, the overall rate of adherence to guidance algorithm (process measure) remained below the target goal of 90%.
Conclusion
This multiphase QI initiative was able to reduce the overall AUR at our NICU. The beneficial impact of this decrease in AUR in preterm infants remains to be determined.</description><identifier>ISSN: 0743-8346</identifier><identifier>EISSN: 1476-5543</identifier><identifier>DOI: 10.1038/s41372-018-0041-y</identifier><identifier>PMID: 29396511</identifier><language>eng</language><publisher>New York: Nature Publishing Group US</publisher><subject>692/700 ; 706/648 ; Algorithms ; Antibiotics ; Blood culture ; Drug therapy ; Infants ; Medicine ; Medicine & Public Health ; Newborn babies ; Pediatric Surgery ; Pediatrics ; Polymerase chain reaction ; Premature babies ; Premature birth ; Quality control ; Quality improvement ; Quality Improvement Article ; Sepsis</subject><ispartof>Journal of perinatology, 2018-04, Vol.38 (4), p.421-429</ispartof><rights>Nature America, Inc., part of Springer Nature 2018</rights><rights>Copyright Nature Publishing Group Apr 2018</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-a44223412f84334b4abdb7f6a7f68b9c61cfc65a887109c2ff9663cf928aff173</citedby><cites>FETCH-LOGICAL-c372t-a44223412f84334b4abdb7f6a7f68b9c61cfc65a887109c2ff9663cf928aff173</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1038/s41372-018-0041-y$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1038/s41372-018-0041-y$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,777,781,27905,27906,41469,42538,51300</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29396511$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bhat, Ramachandra</creatorcontrib><creatorcontrib>Custodio, Haidee</creatorcontrib><creatorcontrib>McCurley, Cathy</creatorcontrib><creatorcontrib>Whitehurst, Richard</creatorcontrib><creatorcontrib>Gulati, Rashmi</creatorcontrib><creatorcontrib>Jha, Om Prakash</creatorcontrib><creatorcontrib>Bhat, Jayalakshmi</creatorcontrib><creatorcontrib>Estrada, Benjamin</creatorcontrib><creatorcontrib>Hill, Amy</creatorcontrib><creatorcontrib>Eyal, Fabien</creatorcontrib><creatorcontrib>Zayek, Michael</creatorcontrib><title>Reducing antibiotic utilization rate in preterm infants: a quality improvement initiative</title><title>Journal of perinatology</title><addtitle>J Perinatol</addtitle><addtitle>J Perinatol</addtitle><description>Background
Judicious use of antibiotic therapy in preterm infants is necessary as prolonged and unwarranted use of antibiotics have been associated with adverse short-term and long-term outcomes.
Local problem
Our baseline data review revealed overuse and unnecessary prolonged antibiotic exposure among preterm infants despite a low suspicion for sepsis.
Methods and interventions
The baseline overall AUR was calculated retrospectively from our pharmacy database for a period of 4 months prior to the quality improvement (QI) initiative (pre-QI phase). The principal QI intervention included the development and implementation of guidance algorithms for evaluation and management of suspected sepsis incorporating key QI measures, such as an emphasis on early discontinuation of antibiotics by 36 h if blood culture remained negative and the introduction of multiplex polymerase chain reaction assay for early identification of causative organisms. This QI initiative was implemented through multiple Plan-Do-Study-Act cycles, starting in February 2016 (QI phase), with an objective to achieve a 10% reduction in the baseline overall AUR by December 2016, in preterm infants with gestational ages between 25
0/7
and 33
6/7
weeks. Data for the QI phase of the study were collected prospectively.
Result
The overall AUR (outcome measure) decreased from 154.8 to 138.4 days of treatment per 1000 hospital days (10.6% decrease,
p
< 0.05) over the 11-month period. However, the overall rate of adherence to guidance algorithm (process measure) remained below the target goal of 90%.
Conclusion
This multiphase QI initiative was able to reduce the overall AUR at our NICU. The beneficial impact of this decrease in AUR in preterm infants remains to be determined.</description><subject>692/700</subject><subject>706/648</subject><subject>Algorithms</subject><subject>Antibiotics</subject><subject>Blood culture</subject><subject>Drug therapy</subject><subject>Infants</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Newborn babies</subject><subject>Pediatric Surgery</subject><subject>Pediatrics</subject><subject>Polymerase chain reaction</subject><subject>Premature babies</subject><subject>Premature birth</subject><subject>Quality control</subject><subject>Quality improvement</subject><subject>Quality Improvement Article</subject><subject>Sepsis</subject><issn>0743-8346</issn><issn>1476-5543</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp1kEtLAzEUhYMotlZ_gBsZcONmNK_JJO6k-AJBEF24Cpk0KSnzaJNMYfz1prYqCC5CAuc7954cAE4RvESQ8KtAESlxDhHPIaQoH_bAGNGS5UVByT4Yw5KSnBPKRuAohAWEG7E8BCMsiGAFQmPw_mJmvXbtPFNtdJXrotNZH13tPlR0XZt5FU3m2mzpTTS-SU-byHCdqWzVq9rFIXPN0ndr05g2JtlFl5xrcwwOrKqDOdndE_B2d_s6fcifnu8fpzdPuU7ZY64oxZhQhC2nhNCKqmpWlZapdHglNEPaalYozksEhcbWCsaItgJzZS0qyQRcbOemEKvehCgbF7Spa9Warg8SifRZwfgXev4HXXS9b1M6iSERuBAFI4lCW0r7LgRvrFx61yg_SATlpne57V2m3uWmdzkkz9lucl81Zvbj-C46AXgLhCS1c-N_V_8_9ROipY71</recordid><startdate>20180401</startdate><enddate>20180401</enddate><creator>Bhat, Ramachandra</creator><creator>Custodio, Haidee</creator><creator>McCurley, Cathy</creator><creator>Whitehurst, Richard</creator><creator>Gulati, Rashmi</creator><creator>Jha, Om Prakash</creator><creator>Bhat, Jayalakshmi</creator><creator>Estrada, Benjamin</creator><creator>Hill, Amy</creator><creator>Eyal, Fabien</creator><creator>Zayek, Michael</creator><general>Nature Publishing Group US</general><general>Nature Publishing 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antibiotic utilization rate in preterm infants: a quality improvement initiative</title><author>Bhat, Ramachandra ; Custodio, Haidee ; McCurley, Cathy ; Whitehurst, Richard ; Gulati, Rashmi ; Jha, Om Prakash ; Bhat, Jayalakshmi ; Estrada, Benjamin ; Hill, Amy ; Eyal, Fabien ; Zayek, Michael</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-a44223412f84334b4abdb7f6a7f68b9c61cfc65a887109c2ff9663cf928aff173</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>692/700</topic><topic>706/648</topic><topic>Algorithms</topic><topic>Antibiotics</topic><topic>Blood culture</topic><topic>Drug therapy</topic><topic>Infants</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Newborn babies</topic><topic>Pediatric Surgery</topic><topic>Pediatrics</topic><topic>Polymerase chain reaction</topic><topic>Premature babies</topic><topic>Premature 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Michael</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Reducing antibiotic utilization rate in preterm infants: a quality improvement initiative</atitle><jtitle>Journal of perinatology</jtitle><stitle>J Perinatol</stitle><addtitle>J Perinatol</addtitle><date>2018-04-01</date><risdate>2018</risdate><volume>38</volume><issue>4</issue><spage>421</spage><epage>429</epage><pages>421-429</pages><issn>0743-8346</issn><eissn>1476-5543</eissn><abstract>Background
Judicious use of antibiotic therapy in preterm infants is necessary as prolonged and unwarranted use of antibiotics have been associated with adverse short-term and long-term outcomes.
Local problem
Our baseline data review revealed overuse and unnecessary prolonged antibiotic exposure among preterm infants despite a low suspicion for sepsis.
Methods and interventions
The baseline overall AUR was calculated retrospectively from our pharmacy database for a period of 4 months prior to the quality improvement (QI) initiative (pre-QI phase). The principal QI intervention included the development and implementation of guidance algorithms for evaluation and management of suspected sepsis incorporating key QI measures, such as an emphasis on early discontinuation of antibiotics by 36 h if blood culture remained negative and the introduction of multiplex polymerase chain reaction assay for early identification of causative organisms. This QI initiative was implemented through multiple Plan-Do-Study-Act cycles, starting in February 2016 (QI phase), with an objective to achieve a 10% reduction in the baseline overall AUR by December 2016, in preterm infants with gestational ages between 25
0/7
and 33
6/7
weeks. Data for the QI phase of the study were collected prospectively.
Result
The overall AUR (outcome measure) decreased from 154.8 to 138.4 days of treatment per 1000 hospital days (10.6% decrease,
p
< 0.05) over the 11-month period. However, the overall rate of adherence to guidance algorithm (process measure) remained below the target goal of 90%.
Conclusion
This multiphase QI initiative was able to reduce the overall AUR at our NICU. The beneficial impact of this decrease in AUR in preterm infants remains to be determined.</abstract><cop>New York</cop><pub>Nature Publishing Group US</pub><pmid>29396511</pmid><doi>10.1038/s41372-018-0041-y</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
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| issn | 0743-8346 1476-5543 |
| language | eng |
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| source | Springer Nature - Complete Springer Journals |
| subjects | 692/700 706/648 Algorithms Antibiotics Blood culture Drug therapy Infants Medicine Medicine & Public Health Newborn babies Pediatric Surgery Pediatrics Polymerase chain reaction Premature babies Premature birth Quality control Quality improvement Quality Improvement Article Sepsis |
| title | Reducing antibiotic utilization rate in preterm infants: a quality improvement initiative |
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