Quality Improvement Methods Increase Appropriate Antibiotic Prescribing for Childhood Pneumonia
Quality Improvement Methods Increase Appropriate Antibiotic Prescribing for Childhood Pneumonia
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DOI：
10.1542/peds.2012-2635
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发表时间：
2013-05-01
期刊：
影响因子：
8
通讯作者：
White, Christine M.
中科院分区：
文献类型：
--
作者：
Ambroggio, Lilliam;Thomson, Joanna;White, Christine M.
目的：2011年8月，儿科传染病学会和美国传染病学会发表了一份关于3个月以上儿童社区获得性肺炎（CAP）管理的循证指南。我们的目的是评估质量改进（QI）的方法，如果可以提高适当的抗生素处方的设置没有一个正式的抗菌药物stewardship programs.METHODS：在三级儿童医院，QI方法被用来快速实施儿科传染病学会/美国传染病学会的指导建议，适当的一线抗生素治疗儿童CAP。QI干预措施侧重于4个关键驱动因素，并分别在急诊科和医院内科住院医师团队中进行测试，使用多个计划-执行-研究-行动周期。每周对符合条件的患者的病历进行审查，以确定推荐的抗生素治疗处方是否成功。这些干预措施对我们结果的影响随时间的推移在运行图上进行跟踪。在急诊科，诊断为CAP的住院儿童的适当一线抗生素处方从中位基线0%增加到100%，在医院内科住院医师团队从30%增加到100%在辛辛那提儿童医院医疗中心当地引入指南后6个月内，并已持续3个月。我们的研究表明，即使在没有正式抗菌药物管理计划的环境中，QI方法也可以快速提高对国家指南的遵守，以鼓励明智地为CAP开出抗生素处方。
OBJECTIVE: In August 2011, the Pediatric Infectious Disease Society and Infectious Disease Society of America published an evidence-based guideline for the management of community-acquired pneumonia (CAP) in children >= 3 months. Our objective was to evaluate if quality improvement (QI) methods could improve appropriate antibiotic prescribing in a setting without a formal antimicrobial stewardship program.METHODS: At a tertiary children's hospital, QI methods were used to rapidly implement the Pediatric Infectious Disease Society/Infectious Disease Society of America guideline recommendations for appropriate first-line antibiotic therapy in children with CAP. QI interventions focused on 4 key drivers and were tested separately in the emergency department and on the hospital medicine resident teams, using multiple plan-do-study-act cycles. Medical records of eligible patients were reviewed weekly to determine the success of prescribing recommended antibiotic therapy. The impact of these interventions on our outcome was tracked over time on run charts.RESULTS: Appropriate first-line antibiotic prescribing for children admitted with the diagnosis of CAP increased in the emergency department from a median baseline of 0% to 100% and on the hospital medicine resident teams from 30% to 100% within 6 months of introducing the guidelines locally at Cincinnati Children's Hospital Medical Center and has been sustained for 3 months.CONCLUSIONS: Our study demonstrates that QI methods can rapidly improve adherence to national guidelines even in settings without a formal antimicrobial stewardship program to encourage judicious antibiotic prescribing for CAP.