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Reducing Vancomycin Use in a Level IV NICU.
Hamdy, Rana F; Bhattarai, Sopnil; Basu, Sudeepta K; Hahn, Andrea; Stone, Brian; Sadler, Eleanor D; Hammer, Benjamin M; Galiote, John; Slomkowski, Julie; Casto, Anne M; Korzuch, Katelyn P; Chase, Hannah; Nzegwu, Nneka; Greenberg, Isabella; Ortiz, Noelle; Blake, Carmen; Chang, Jaeho; Bost, James E; Payne, Asha S; Shah, Rahul K; Soghier, Lamia.
Afiliación
  • Hamdy RF; Infectious Diseases, rhamdy@childrensnational.org.
  • Bhattarai S; Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia; and.
  • Basu SK; Quality and Patient Safety.
  • Hahn A; Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia; and.
  • Stone B; Neonatology.
  • Sadler ED; Infectious Diseases.
  • Hammer BM; Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia; and.
  • Galiote J; Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia; and.
  • Slomkowski J; Neonatology.
  • Casto AM; Pharmacy.
  • Korzuch KP; Pharmacy.
  • Chase H; Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia; and.
  • Nzegwu N; Neonatology.
  • Greenberg I; Pharmacy Residency Preceptor Program, Boston Medical Center, Boston, Massachusetts.
  • Ortiz N; Neonatology.
  • Blake C; Department of Nursing, Children's National Hospital, Washington, District of Columbia.
  • Chang J; Neonatology.
  • Bost JE; Children's National Research Institute and.
  • Payne AS; Divisions of Biostatistics and Study Methodology.
  • Shah RK; Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia; and.
  • Soghier L; Neonatology.
Pediatrics ; 146(2)2020 08.
Article en En | MEDLINE | ID: mdl-32611807
BACKGROUND AND OBJECTIVES: Vancomycin remains one of the most commonly prescribed antibiotics in NICUs despite recommendations to limit its use for known resistant infections. Baseline data revealing substantially higher vancomycin use in our NICU compared to peer institutions informed our quality improvement initiative. Our aim was to reduce the vancomycin prescribing rate in neonates hospitalized in our NICU by 50% within 1 year and sustain for 1 year. METHODS: In the 60-bed level IV NICU of an academic referral center, we used a quality improvement framework to develop key drivers and interventions including (1) physician education with benchmarking antibiotic prescribing rates; (2) pharmacy-initiated 48-hour antibiotic time-outs on rounds; (3) development of clinical pathways to standardize empirical antibiotic choices for early-onset sepsis, late-onset sepsis, and necrotizing enterocolitis; coupled with (4) daily prospective audit with feedback from the antimicrobial stewardship program. RESULTS: We used statistical process u-charts to show vancomycin use declined from 112 to 38 days of therapy per 1000 patient-days. After education, pharmacy-initiated 48-hour time-outs, and development of clinical pathways, vancomycin use declined by 29%, and by an additional 52% after implementation of prospective audit with feedback. Vancomycin-associated acute kidney injury also declined from 1.4 to 0.1 events per 1000 patient-days. CONCLUSIONS: Through a sequential implementation approach of education, standardization of care with clinical pathways, pharmacist-initiated 48-hour time-outs, and prospective audit with feedback, vancomycin days of therapy declined by 66% over a 1-year period and has been sustained for 1 year.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Vancomicina / Unidades de Cuidado Intensivo Neonatal / Prescripción Inadecuada / Programas de Optimización del Uso de los Antimicrobianos Tipo de estudio: Guideline / Observational_studies / Risk_factors_studies Límite: Humans / Newborn País/Región como asunto: America do sul / Brasil Idioma: En Revista: Pediatrics Año: 2020 Tipo del documento: Article Pais de publicación: Estados Unidos
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Vancomicina / Unidades de Cuidado Intensivo Neonatal / Prescripción Inadecuada / Programas de Optimización del Uso de los Antimicrobianos Tipo de estudio: Guideline / Observational_studies / Risk_factors_studies Límite: Humans / Newborn País/Región como asunto: America do sul / Brasil Idioma: En Revista: Pediatrics Año: 2020 Tipo del documento: Article Pais de publicación: Estados Unidos