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

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

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.

Implementing a Quality Improvement Initiative for Asthma Management in a Tribal Clinic

2005 ◽  
Author(s):  
Charlanne J. FitzGerald ◽  
Beverly Hart ◽  
Adrienne Laverdure ◽  
Brian Schafer
Keyword(s):  
Quality Improvement ◽  
Asthma Management ◽  
Quality Improvement Initiative

A Patient-Driven Quality Improvement Initiative for Pituitary Adenoma Care

2020 ◽  
Author(s):  
Irene Druce ◽  
Mary-Anne Doyle ◽  
Amel Arnaout ◽  
Dora Liu ◽  
Fahad Alkherayf ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Pituitary Adenoma ◽  
Quality Improvement Initiative

1209-P: A Quality Improvement Initiative to Increase Utilization of Continuous Glucose Monitors Results in Improved Glycemic Outcomes in a Pediatric Diabetes Clinic

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1209-P
Author(s):  
KATHRYN OBRYNBA ◽  
JUSTIN A. INDYK ◽  
KAJAL GANDHI ◽  
DON A. BUCKINGHAM ◽  
TRAVIS WELLS ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Improvement Initiative ◽  
Diabetes Clinic ◽  
Pediatric Diabetes ◽  
Continuous Glucose Monitors ◽  
Glycemic Outcomes
Sign in / Sign up

Export Citation Format

Share Document