Implementing a Discharge Stewardship Bundle to improve antibiotic use at transition from hospital to home

项目摘要/摘要 儿科抗生素管理计划(ASP)在医院和门诊环境中优化使用 抗生素可改善临床结果，减少药物不良事件，并减少 抗药性细菌。然而，在患者从出院到出院过渡期间的管理 家，或“出院管家”，是一种未得到满足的需求，原因有几个。首先，很少有儿科管理工作 程序执行出院管理。其次，大约30%的儿科患者接受抗生素治疗 在医院出院。第三，为住院患者开出的大部分抗生素使用日发生在 出院。第四，多达一半的出院抗生素处方是次优的，这包括选择 错误的药物、剂量、治疗路线或疗程。该项目将使用实施科学框架来 开发、实施和测试多方面的出院管理干预措施的有效性 具有住院儿童抗生素处方的三个最常见适应症的住院儿童- 社区获得性肺炎(CAP)、尿路感染(UTI)和皮肤/软组织感染(SSTI)-在 四家儿童医院，为今后扩大到更多的目标人群奠定基础。 将讨论抗生素的选择、剂量、治疗路线和持续时间。目标1是发展、本地适应和 在四个参与地点实施排放管理干预。一体化推进 卫生服务研究实施行动(I-PARIHS)框架将指导快速形成 评估以确定可能促进或阻碍排放执行的背景因素 每个站点的管理干预。根据这些结果，当地的促进者将致力于制定和 实施由共识驱动的临床处方指南组成的出院管理干预 对于CAP、UTI和SSTI，以及基于这些指南的处方数据的季度反馈。目标2是 衡量出院管理干预对抗生素处方的影响(主要结果) 和以病人为中心的平衡措施。对于主要结果，次优抗生素处方，我们将 使用回溯性数据收集，利用经过验证的基于代码的诊断算法最大限度地 今后传播的一致性和可行性。对于平衡指标、治疗失败和治疗后 出院药物不良事件，我们将使用从CAP患者父母那里收集的前瞻性数据， 和SSTI来最大限度地捕获它们。这两个次级目标都将利用基于18个月的时间序列分析 干预前数据，随后是干预后30个月的数据。该项目将为以下项目奠定基础 未来向更广泛的患者群体传播出院管理。调查人员对此进行了调查 来自共享儿科管理抗菌报告的领导层的提案(夏普斯) 协作，一个由北美60多家儿童医院组成的网络，它是独一无二的 定位于采取针对出院时处方的抗菌管理干预措施。

Project Summary / Abstract Pediatric antibiotic stewardship programs (ASPs) in hospital and outpatient settings optimize the use of antibiotics to improve clinical outcomes, decrease adverse drug events, and reduce the emergence of antibiotic resistant bacteria. However, stewardship for patients at the transition from hospital discharge to home, or “discharge stewardship,” is an unmet need for several reasons. First, few pediatric stewardship programs perform discharge stewardship. Second, approximately 30% of pediatric patients receive antibiotics at hospital discharge. Third, the majority of antibiotic days prescribed for hospitalized patients occur after discharge. Fourth, up to half of discharge antibiotic prescriptions are suboptimal, which includes choosing the wrong drug, dose, route, or duration of therapy. This project will use an implementation science framework to develop, implement, and test the effectiveness of a multifaceted discharge stewardship intervention for hospitalized children with the three most common indications for antibiotic prescribing in hospitalized children - community-acquired pneumonia (CAP), urinary tract infections (UTI), and skin/soft tissue infections (SSTI) - at four children's hospitals to establish a foundation for future expansion to additional target populations. Antibiotic choice, dose, route, and duration of therapy will be addressed. Aim 1 is to develop, locally adapt, and implement a discharge stewardship intervention across the four participating sites. The integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework will guide a rapid formative evaluation to identify contextual factors likely to facilitate or hinder the implementation of a discharge stewardship intervention at each site. Based on these results, local facilitators will work to develop and implement a discharge stewardship intervention comprised of consensus driven clinical prescribing guidelines for CAP, UTI, and SSTI plus quarterly feedback of prescribing data based on these guidelines. Aim 2 is to measure the impact of the discharge stewardship intervention on antibiotic prescribing (the primary outcome) and patient-centered balancing measures. For the primary outcome, suboptimal antibiotic prescribing, we will use retrospective data collection leveraging validated diagnostic code-based algorithms to maximize consistency and feasibility for future dissemination. For the balancing metrics, treatment failure and post- discharge adverse drug events, we will use prospective data collection from parents of patients with CAP, UTI, and SSTI to maximize their capture. Both sub-aims will utilize a time series analysis based on 18 months of pre-intervention data followed by 30 months of post-intervention data. This project will form the foundation for future dissemination of discharge stewardship to a broader array of patient populations. Investigators on this proposal form the leadership of the Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS) Collaborative, a network comprised of more than 60 children's hospitals across North America that is uniquely positioned to adopt antimicrobial stewardship interventions designed to target prescribing at hospital discharge.