Rationalising antibiotic use after low-risk vaginal deliveries in a hospital setting in India
Autor: | Nikita Kumari, Saru Bhartia, Yashika Malhotra, Shakti Sharma, Rinku Sengupta |
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Jazyk: | angličtina |
Rok vydání: | 2021 |
Předmět: |
Medicine (General)
Quality Improvement Report Leadership and Management Psychological intervention Antimicrobial Stewardship 03 medical and health sciences control charts/run charts 0302 clinical medicine Documentation R5-920 Pregnancy Intervention (counseling) Employee engagement Health care Humans Medicine clinical protocols 030212 general & internal medicine Antibiotic use Antibiotic prophylaxis obstetrics and gynecology business.industry 030503 health policy & services Health Policy Public Health Environmental and Occupational Health Delivery Obstetric medicine.disease Hospitals Anti-Bacterial Agents Female Medical emergency healthcare quality improvement PDSA 0305 other medical science business Delivery of Health Care PDCA |
Zdroj: | BMJ Open Quality, Vol 10, Iss Suppl 1 (2021) BMJ Open Quality |
ISSN: | 2399-6641 |
Popis: | BackgroundIn 2017, a postoperative multidrug resistant case of urinary tract infection made obstetricians at Sitaram Bhartia Institute of Science and Research introspect the antibiotic usage in labouring mothers. Random case file reviews indicated overuse and variability of practice among care providers. This prompted us to explore ways to rationalise antibiotic use.MethodsA multidisciplinary team of obstetricians, paediatricians and quality officers was formed to run this improvement initiative at a private hospital facility in India. Review of literature advocated formulating a departmental antibiotic policy. Creating this policy and implementing it using improvement methodology helped us rationalise antibiotic usage.InterventionsWe aimed to reduce the use of antibiotics from 42% to less than 10% in uncomplicated vaginal deliveries. We tested a series of sequential interventions using the improvement methodology of Plan–Do–Study–Act (PDSA) cycles, an approach recommended by the Institute for Healthcare Improvement. Learning from the PDSA cycle of the previous intervention helped decide the subsequent change ideas. The interventions included creation of a departmental antibiotic policy, staff engagement, and modification in documentation, concept of dual responsibility and team huddles as feedback opportunities. Information was analysed to understand the progress and improvement with change ideas.ResultsBackground analysis revealed that antibiotic usage ranged from 24% to 69% and average rate of antibiotic prophylaxis was high (42.28%) in low-risk uncomplicated vaginal deliveries. The sequential changes resulted in reduction in antibiotic usage to 10% in the target population by 4 months. Sustained improvement was noted in the following months.ConclusionWe succeeded in implementing a departmental antibiotic policy aligning it with existing international guidelines and our local challenges. Antibiotic stewardship was one of the first major steps in our journey to avoid multidrug-resistant infections. Sustaining outcomes will involve continuous feedback to ensure engagement of all stakeholders in a hospital setting. |
Databáze: | OpenAIRE |
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