Implementation and Evaluation of a Video-based Prospective Feedback Intervention to Improve Antimicrobial Stewardship in Neonatal Intensive Care Units

摘要/摘要 滥用抗菌剂的问题是众所周知的，是所有主要 公共卫生、传染病和美国初级保健协会。这反映了无法治疗的疾病的存在。 细菌感染，制造商生产新抗生素的渠道很浅，以及继续滥用 供应商提供的抗菌药。在新生儿重症监护病房(NICU)环境中，抗生素是最多的 经常使用的药物，而且往往不适当。这种用法与增加 细菌耐药性，住院时间增加，坏死性小肠结肠炎，甚至死亡。药效 在NICU中可能很难做出使用决定，因为感染和非感染的情况相似 经常导致经验式的过度治疗。因此，抗生素有很大的变化也就不足为奇了。 在NICU中使用。抗菌素管理计划(ASP)可缓解贫穷的后果 使用抗生素可以改善患者的预后，减少不良事件，改善细菌 感受性和经济储蓄。尽管很常见，但还是推荐了几种ASP策略 实施问题包括缺乏提供商的认可、对最佳实践的共识、对 处方者和其他管理患者的工作人员之间的互动，以及根据临床和 制度背景。这些挑战在患者高度异质性的环境中加剧 目前存在适应症和缺乏关于治疗的专家共识，例如NICU。 我们建议评估一种创新的、可扩展的抗菌管理干预措施，称为ECHO- NICU中的ASP参与了美国最大的全州围产期QI协作。干预措施 将预期反馈(CDC推荐的ASP实践)与ECHO远程学习平台配对 《社区卫生保健成果推广》。回声是一种基于证据的实践方法 自2003年以来，在全球120个卫生协作中使用了传播。ECHO的两个部分--ASP 干预--前瞻性反馈和ECHO方法--以专家为基础， 基于案例的学习模式是为临床医生如何倾向于学习和建立实践共识而量身定做的。 该项目的具体目标是：1)评估ECHO-ASP干预措施的实施情况 包括实施的障碍和促进者、基于视频的潜在客户的现场参与 反馈和审计会议，将会议结果传播给其他当地NICU处方者，意识到 干预的可接受性和持久性，以及对抗生素处方的实践共识；2) 评估Echo ASP干预对包括抗生素在内的患者护理结果的有效性 用法、与药物相关的不良事件和其他临床并发症；3)评估 附和ASP干预措施，包括实施成本和对护理成本的影响。

Summary/Abstract The problem of antimicrobial misuse is well known and is a high priority action item for all of the major public health, infectious disease and US primary care societies. This reflects the existence of untreatable bacterial infections, a shallow manufacturer pipeline for new antibiotics, and continued misuse of antimicrobials by providers. In the neonatal intensive care unit (NICU) setting, antibiotics are the most frequently used medications, and very often inappropriately. Such use is associated with increased bacterial resistance, increased hospital length of stay, necrotizing enterocolitis, and even death. Drug usage decisions can be difficult in the NICU as infectious and non‐infectious conditions present similarly often leading to empiric overtreatment. Thus, it is not surprising there is substantial variation in antibiotic use among NICUs. Antimicrobial stewardship programs (ASP) mitigate against the consequences of poor antibiotic use resulting in improved patient outcomes, fewer adverse events, improved bacterial susceptibilities, and economic savings. Several ASP strategies are recommended, however common implementation problems include lack of provider buy‐in, consensus on best practice, attention to interactions among prescribers and other staff who manage patients, and tailoring of ASPs to clinical and institutional contexts. These challenges are exacerbated in settings in which high heterogeneity in patient indications and lack of expert consensus on treatment is present, such as the NICU. We propose to evaluate an innovative, scalable antimicrobial stewardship intervention called ECHO‐ ASP in NICUs participating in the largest statewide perinatal QI collaborative in the US. The intervention pairs prospective feedback (an ASP practice recommended by CDC) with the ECHO tele‐learning platform (Extension for Community Healthcare Outcomes). ECHO is an evidence‐based method of practice dissemination used globally in >120 health collaborations since 2003. Both parts of the ECHO‐ASP intervention—prospective feedback and the ECHO methodology—are grounded in an expert‐facilitated, case‐based learning model tailored to how clinicians are inclined to learn and build practice consensus. The Specific Aims of the project are to: 1) Evaluate the implementation of the ECHO‐ASP intervention including barriers and facilitators to implementation, site participation in video‐based prospective feedback and audit sessions, dissemination of session results to other local NICU prescribers, perceived acceptability and durability of the intervention, and practice consensus on antibiotic prescribing; 2) Evaluate the effectiveness of the ECHO ASP intervention on patient care outcomes, including antibiotic use, drug‐related adverse events, and other clinical complications; 3) Evaluate the cost implications of the ECHO ASP intervention, including implementation costs and effects on costs of care.