Improving intravenous-to-oral antibiotic switch in children: a team-based audit and implementation approach

BMJ Open Quality

article

Brendan Joseph McMullan¹  Michelle Mahony¹  Lolita Java⁴  Mona Mostaghim⁵  Michael Plaister⁶  Camille Wu³  Sophie White¹  Laila Al Yazidi¹  Erica Martin⁹  Penelope Bryant^1,10  Karin A Thursky²  Evette Buono⁴ 

[1] Department of Immunology and Infectious Diseases , Sydney Children's Hospital Randwick;NHMRC National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne , Peter MacCallum Cancer Institute;School of Women's and Children's Health , University of New South Wales;Medication Safety , Clinical Excellence Commission;Pharmacy Department , Sydney Children's Hospital Randwick;Department of General Paediatrics , Sydney Children's Hospital Randwick;Department of Paediatric Surgery , Sydney Children's Hospital Randwick;Child Health Department , Sultan Qaboos University;Department of Nursing , Sydney Children's Hospital Randwick;Infectious Diseases and Hospital in the Home Departments , The Royal Children's Hospital;Clinical Paediatrics , Murdoch Childrens Research Institute;National Centre for Antimicrobial Stewardship , The Peter Doherty Institute for Infection and Immunity

关键词: antibiotic management;    audit and feedback;    healthcare quality improvement;    teamwork;    paediatrics;   

DOI  :  10.1136/bmjoq-2020-001120

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Children in hospital are frequently prescribed intravenous antibiotics for longer than needed. Programmes to optimise timely intravenous-to-oral antibiotic switch may limit excessive in-hospital antibiotic use, minimise complications of intravenous therapy and allow children to go home faster. Here, we describe a quality improvement approach to implement a guideline, with team-based education, audit and feedback, for timely, safe switch from intravenous-to-oral antibiotics in hospitalised children. Eligibility for switch was based on evidence-based guidelines and supported by education and feedback. The project was conducted over 12 months in a tertiary paediatric hospital. Primary outcomes assessed were the proportion of eligible children admitted under paediatric and surgical teams switched within 24 hours, and switch timing prior to and after guideline launch. Secondary outcomes were hospital length of stay, recommencement of intravenous therapy or readmission. The percentage of children switched within 24 hours of eligibility significantly increased from 32/50 (64%) at baseline to 203/249 (82%) post-implementation (p=0.006). The median time to switch fell from 15 hours 42 min to 4 hours 20 min (p=0.0006). In addition, there was a 14-hour median reduction in hospital length of stay (p=0.008). Readmission to hospital and recommencement of intravenous therapy did not significantly change postimplementation. This education, audit and feedback approach improved timely intravenous-to-oral switch in children and also allowed for more timely discharge from hospital. The study demonstrates proof of concept for this implementation with a methodology that can be readily adapted to other paediatric inpatient settings.antibiotic managementaudit and feedbackhealthcare quality improvementteamworkpaediatricshttp://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

【 授权许可】

CC BY-NC|CC BY|CC BY-NC-ND