Operationalising outpatient antimicrobial stewardship to reduce system-wide antibiotics for acute bronchitis

BMJ Open Quality

article

Morgan Clouse Johnson¹  Todd Hulgan²  Robin G Cooke⁴  Ruth Kleinpell¹  Christianne Roumie¹  Carol Callaway-Lane¹  Lauren D Mitchell¹  Jacob Hathaway⁷  Robert Dittus¹  Milner Staub¹ 

[1] Geriatric Research, Education and Clinical Center ,(GRECC) , VA Tennessee Valley Healthcare System Nashville Campus;Infectious Diseases , VA Tennessee Valley Healthcare System Nashville Campus;Infectious Diseases , Vanderbilt University Medical Center;Pharmacy , VA Tennessee Valley Healthcare System Nashville Campus;School of Nursing , Vanderbilt University;Internal Medicine , Vanderbilt University Medical Center;Primary Care , VA Tennessee Valley Healthcare System Nashville Campus;Internal Medicine and Public Health , Vanderbilt University Medical Center

关键词: antibiotic management;    quality improvement;    PDSA;    audit and feedback;    control charts/run charts;   

DOI  :  10.1136/bmjoq-2020-001275

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Background Antibiotics are not recommended for treatment of acute uncomplicated bronchitis (AUB), but are often prescribed (85% of AUB visits within the Veterans Affairs nationally). This quality improvement project aimed to decrease antibiotic prescribing for AUB in community-based outpatient centres from 65% to <32% by April 2020.Methods From January to December 2018, community-based outpatient clinics’ 6 months’ average of prescribed antibiotics for AUB and upper respiratory infections was 63% (667 of 1054) and 64.6% (314 of 486) when reviewing the last 6 months. Seven plan–do–study–act (PDSA) cycles were implemented by an interprofessional antimicrobial stewardship team between January 2019 and March 2020. Balancing measures were a return patient phone call or visit within 4 weeks for the same complaint. Χ2 tests and statistical process control charts using Western Electric rules were used to analyse intervention data.Results The AUB antibiotic prescribing rate decreased from 64.6% (314 of 486) in the 6 months prior to the intervention to 36.8% (154 of 418) in the final 6 months of the intervention. No change was seen in balancing measures. The largest reduction in antibiotic prescribing was seen after implementation of PDSA 6 in which 14 high prescribers were identified and targeted for individualised reviews of encounters of patients with AUB with an antimicrobial steward.Conclusions Operational implementation of successful stewardship interventions is challenging and differs from the traditional implementation study environment. As a nascent outpatient stewardship programme with limited resources and no additional intervention funding, we successfully reduced antibiotic prescribing from 64.6% to 36.8%, a reduction of 43% from baseline. The most success was seen with targeted education of high prescribers.

【 授权许可】

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