scholarly journals 61. A Multidisciplinary Quality Improvement Initiative to Promote Penicillin Allergy Delabeling

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S148-S149
Author(s):  
Lea Monday ◽  
Jaclyn Michniak ◽  
Edward Zoratti ◽  
Allison J Weinmann
Keyword(s):  
Quality Improvement ◽  
Antibiotic Use ◽  
Quality Improvement Initiative ◽  
Antimicrobial Use ◽  
Urban Hospital ◽  
Post Discharge ◽  
Chi Square ◽  
Narrow Spectrum ◽  
Part Time ◽  
First And Second Generation

Abstract Background Penicillin (PCN) allergies are reported in up to 10% patients and are associated with adverse clinical and antimicrobial stewardship outcomes. Here we describe a multidisciplinary quality improvement (QI) initiative to facilitate PCN delabeling at a large urban hospital. Methods Starting in August 2020, the departments of Allergy and Infectious Diseases (ID) began a joint QI effort to employ a part time allergist nurse practitioner (ANP) for PCN allergy assessment and delabeling. The ANP used a daily system generated list to identify and assess adult patients with PCN allergy and contact teams to request a consult. An ID fellow also assisted with identifying patients and contacting care teams. The ANP then offered skin/oral PCN challenge or direct label removal based on history after discussion with an allergist physician. Baseline, clinical, and allergy characteristics were compared between patients delabeled and not delabeled using Chi-square and Mann-Whitney U test. Primary endpoints were antibiotic utilization outcomes from index admission post ANP assessment to 30-days post discharge. Secondary endpoints included readmission, length of stay (LOS), mortality, and sustained removal of the PCN allergy at 30-days. Results Between 30 August 2020 and 6 May 2021 (250 days), 139 PCN allergic patients were assessed (81 delabeled versus 58 not delabeled) (Figure 2). Some patients (37%) were delabeled via history alone, while 63% had further skin/oral testing. Baseline characteristics were similar between groups (Table 1). In the delabeled group, we observed increased narrow-spectrum PCN use (p< 0.001), and decreased vancomycin (p< 0.001), fluoroquinolone (p=0.013), carbapenem (p< 0.011), and overall restricted antimicrobial use (Table 2). Rates of 30-day readmission, LOS, and mortality were comparable. Four (5%) of delabeled patients had had PCN allergy re-entered in the chart at 30-days. Patients were similar between groups on all baseline clinical and allergy characteristics except for more patients with infection classified as “other” in the non-delabeled group. In the delabeled patients, we observed increased narrow-spectrum PCN use and decreased vancomycin, fluoroquinolone, carbapenem, and overall restricted antimicrobial use. Use of first and second generation cephalosporines was comparable between groups. Rates of 30-day readmission, LOS, and mortality were comparable. Conclusion This QI effort between the departments of Allergy and ID to employ an ANP increased narrow spectrum antibiotic use and reduced use of restricted antimicrobials. Challenges included the part time position of the ANP unable to see every patient, reemergence of allergy in the chart, and clinical or other exclusions for delabeling (Fig 3). Disclosures All Authors: No reported disclosures

Reduction in Post-Discharge Return to Acute Care in Hepatopancreatobiliary Surgery: Results of a Quality Improvement Initiative

2020 ◽  
Vol 231 (2) ◽  
pp. 231-238
Author(s):  
Brendan P. Lovasik ◽  
Catherine M. Blair ◽  
Lori A. Little ◽  
Marty Sellers ◽  
John F. Sweeney ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Acute Care ◽  
Quality Improvement Initiative ◽  
Post Discharge ◽  
Hepatopancreatobiliary Surgery

scholarly journals Evaluating antibiotic use and developing a tool to optimize prescribing in a family-centered HIV clinic in Eswatini

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244247
Author(s):  
Tara E. Ness ◽  
Ashish E. Streatfield ◽  
Tandzile Simelane ◽  
Abiy Korsa ◽  
Sandile Dlamini ◽  
...  
Keyword(s):  
Initial Period ◽  
Antibiotic Use ◽  
World Health ◽  
Antimicrobial Use ◽  
Chi Square ◽  
Immunodeficiency Virus ◽  
Before And After ◽  
Chi Square Test ◽  
Health Organization ◽  
Family Centered

In a human immunodeficiency virus (HIV) clinic for children and their families in Eswatini, we sought to understand the use of antibiotics and identify specific areas for improvement. We performed a retrospective patient chart review as part of a quality improvement (QI) initiative to assess antimicrobial use before and after implementation of a standardized antimicrobial guide. For each prescribing period, 100 random patient encounters were selected for review if the indication for antibiotics, duration, and dose were consistent with World Health Organization (WHO) guidelines. Two physicians reviewed each encounter using a structured abstraction tool, with a third resolving discrepancies. Results were analyzed using a chi-square test of proportions and a structured survey was performed to assess perceptions of the guide. After the implementation of an antimicrobial guide, there was a significant decrease in the proportion of clinic visits with an antibiotic prescribed (p < 0.001). Incorrect indication for antimicrobial use decreased from 20.4% in the initial period to 10.31% and 10.2% but did not reach significance (p = .0621) in the subsequent periods after implementation. Incorrect dose/duration decreased from 10.47% in the initial period to 7.37% and 3.1% in the subsequent periods, but this was also was not significant (p = 0.139). All prescribers who completed the survey felt that it positively impacted their prescribing. Our study found that an antimicrobial guide reduced and improved the prescription of antimicrobials, demonstrating practical solutions can have a lasting impact on prescribing in low resource settings.

scholarly journals Care transition from rehabilitation to home: A QI project using the RED Toolkit to decrease readmission rates

2021 ◽  
Vol 10 (1) ◽  
pp. 46
Author(s):  
Jennifer R. Bernard ◽  
Eileen L. Creel ◽  
Rhonda K Pecoraro
Keyword(s):  
Quality Improvement ◽  
Hip Fracture ◽  
Healthcare Providers ◽  
Inpatient Rehabilitation ◽  
Care Plan ◽  
Quality Improvement Initiative ◽  
Evidence Based ◽  
Discharge Process ◽  
Post Discharge ◽  
Post Intervention

Objective: This quality improvement (QI) project’s aim was to lower 30-day healthcare reutilization for patients aged 50 or older with hip fracture using an evidence-based discharge process method, the Re-Engineered Discharge (RED) Toolkit.Methods: The QI project of a revised patient discharge process to lower healthcare reutilization of Baton Rouge Rehabilitation Hospital (BRRH) hip fracture patients was implemented as an evidence-based quality improvement initiative. Inpatient and outpatient discharge process revisions were implemented at an inpatient rehabilitation facility (IRF) based on Re-Engineered Discharge (RED) Toolkit recommendations. Inpatient revisions included patient barrier identification with associated documentation changes to the IRF interdisciplinary team form. Outpatient modifications consisted of an After-Hospital Care Plan (AHCP), and two post-discharge Telephone Follow-Up (TFU) calls.Results: Healthcare reutilization and thirty-day hospital readmission for this project were measured at 8.5% and 5.7%, respectively. A decrease in healthcare reutilization of at least 1.6% was observed for the IRF. Most participants scored at a high level (88.6%) of “patient knowledge of self-management” post intervention. Out of participants who did not attend their first Primary Care Provider (PCP) appointment, 33.3% experienced healthcare reutilization. This result emphasized the importance of seeing one’s PCP post-discharge. Patient satisfaction increased by 5% and 6.73%, measured by Hospital Consumer Assessment of HealthCare Providers and Systems (HCAHP) scores for nursing care and physician care, respectively.Conclusions: Implementation of a RED Toolkit-based discharge process at an IRF positively impacted all three study outcomes and associated healthcare costs in lowering preventable readmissions.

scholarly journals 162. Duration of Antibiotics Through Care Transitions: A Quality Improvement Initiative

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S191-S191
Author(s):  
Caitlin Soto ◽  
Kate Dzintars ◽  
Kate Dzintars ◽  
Sara C Keller
Keyword(s):  
Care Transitions ◽  
Total Duration ◽  
Antibiotic Use ◽  
Discharge Summary ◽  
Quality Improvement Initiative ◽  
Antibiotic Prescribing ◽  
Post Discharge ◽  
Term Care ◽  
Antibiotic Duration

Abstract Background Antibiotic resistance is increasing worldwide, largely driven by excessive antibiotic use. Antibiotic stewardship (AS) interventions have traditionally focused on acute care, long-term care, and ambulatory settings. However, as patients transition from one care setting to another, AS interventions should address antibiotic orders (agent, dose, duration) between the hospital and the home. The purpose of this study is to determine the appropriateness of a total course of antibiotics, including inpatient and outpatient prescriptions, to aid in prioritizing AS interventions. Methods A single-center, retrospective study was performed to evaluate antibiotic duration for adult patients discharged from a large quaternary-care academic hospital. All antibiotic prescribing data, including pre-admission, during admission, and after hospital discharge, as well as information on indication, was collected from the electronic medical record. Descriptive statistics were used to summarize the data collected. Results 196 patients were included in the study. There were 100 instances of disagreement on antibiotic indication between the discharge summary and reviewer. However, 70% of patients were discharged on an appropriate antibiotic. The majority of patients (75%) were prescribed excess antibiotic days beyond guideline recommended total duration, and 68% of patients did not have appropriate duration of antibiotics post-discharge. Of those with excess duration, 31% were prescribed penicillins, 23% were prescribed cephalosporins, and 20% were prescribed trimethoprim/sulfamethoxazole. Excess antibiotic duration was associated most commonly with an unknown diagnosis (23%), a skin and soft tissue infection diagnosis (16%), and antibiotic prophylaxis (12%). Conclusion The results of this study showed that patients were often prescribed excess antibiotics at discharge, and the total duration of antibiotics from pre-admission to post-discharge were prolonged beyond guideline-recommended duration. Understanding the total duration of antibiotic prescription, including post-discharge and pre-admission durations, is key in assessing risk from antibiotics and targeting AS interventions. Disclosures Kate Dzintars, PharmD, Nothing to disclose

scholarly journals A Quality Improvement Initiative To Optimize Antibiotic Use in a Level 4 NICU

PEDIATRICS ◽  
2020 ◽  
Vol 146 (5) ◽  
pp. e20193956
Author(s):  
Jeffrey M. Meyers ◽  
Jamey Tulloch ◽  
Kristen Brown ◽  
Mary T. Caserta ◽  
Carl T. D’Angio ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Antibiotic Use ◽  
Quality Improvement Initiative

Antibiotic Use During Obstetric Anal Sphincter Injury: a Quality Improvement Initiative [30G]

2019 ◽  
Vol 133 (1) ◽  
pp. 81S-81S
Author(s):  
Caroline Ann Kieserman-Shmokler ◽  
Meghan Donald Bugosh ◽  
Dee E. Fenner ◽  
Carolyn Weaver Swenson
Keyword(s):  
Quality Improvement ◽  
Anal Sphincter ◽  
Antibiotic Use ◽  
Obstetric Anal Sphincter Injury ◽  
Quality Improvement Initiative ◽  
Sphincter Injury ◽  
Anal Sphincter Injury

scholarly journals 1096. Reducing Unnecessary Postoperative Antibiotic Prophylaxis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S389-S390
Author(s):  
Talene A Metjian ◽  
Jeffrey Gerber ◽  
Adam Watson ◽  
Caroline Burlingame ◽  
Heuer Gregory ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Antibiotic Prophylaxis ◽  
Adverse Drug Events ◽  
Tethered Cord ◽  
Surgical Site Infections ◽  
Antibiotic Use ◽  
Quality Improvement Initiative ◽  
National Guidelines ◽  
Post Intervention ◽  
Stewardship Program

Abstract Background National guidelines for the prevention of surgical site infections (SSI) recommend against antibiotic prophylaxis following wound closure for clean and clean-contaminated surgical procedures. Prolonged antibiotic prophylaxis can lead to antibiotic resistance and adverse drug events without reducing SSI rates. The objective was to reduce the rate of antibiotic prophylaxis following surgical incision closure for specified procedures in the Divisions of Neurosurgery (NRS), Otolaryngology (OTO), and General Surgery (GS) at Children’s Hospital of Philadelphia (CHOP). Methods We identified all NRS, OTO, and GS procedures conducted at CHOP from July 1, 2016 to June 20, 2017. Collaborative meetings between surgical quality improvement team leads and the antimicrobial stewardship program (ASP) were convened to identify procedures most suitable for the intervention, including Chiari decompressions and tethered cord repair (NRS); tympanoplasty and tracheostomy (OTO); and laparoscopic and thoracoscopic procedures (GS). The intervention, started in March 2018, included (1) education of surgeons on perioperative prescribing guidelines, (2) order set modification, and (3) individualized monthly audit with feedback reports of inappropriate postoperative prescribing (via email copying all surgeons within the division). We monitored rates utilizing SPC charts of postoperative antibiotic use (defined as administration within 24 hours of procedure end) and evaluated SSI rates pre and post-intervention with a Poisson regression. Results Following the intervention, postoperative antibiotic use reached special cause resulting in a mean decline for laparoscopy (19.6% to 11.7%), thoracoscopy (35.6% to 17.9%), tympanoplasty (90.5% to 11.4%), tethered cord repair (95% to 25.5%), and Chiari decompression (97% to 45.9%). There was no mean shift in postoperative antibiotic use for tracheostomy (25.5%). 30-day SSI rates did not change pre- and post-intervention (P = 0.36). Conclusion A quality improvement initiative conducted to implement national guidelines recommending against postoperative antibiotic prophylaxis showed a significant reduction in postoperative antibiotic prophylaxis without a concomitant rise in SSI rates. Disclosures All authors: No reported disclosures.

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