An Ambulatory Antimicrobial Stewardship Initiative to Improve Diagnosis and Treatment of Urinary Tract Infections in Children
| Autor: | Zachary Willis, Jennifer D’Auria, Christine M. Walsh-Kelly, Elizabeth Walters, Daniel Park, Cheryl L. Jackson |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Leadership and Management Urinary system MEDLINE Drug resistance urologic and male genital diseases 03 medical and health sciences Antimicrobial Stewardship 0302 clinical medicine Antibiotic resistance Drug Resistance Bacterial medicine Antimicrobial stewardship Humans 030212 general & internal medicine Medical prescription Child Urine Specimen Collection business.industry 030503 health policy & services Infant Hospitals Pediatric Quality Improvement female genital diseases and pregnancy complications Anti-Bacterial Agents Specimen collection Child Preschool Ambulatory Emergency medicine Practice Guidelines as Topic Urinary Tract Infections Female Guideline Adherence 0305 other medical science business Algorithms |
| Zdroj: | Joint Commission journal on quality and patient safety. 45(12) |
| ISSN: | 1938-131X |
| Popis: | Background Antibiotic stewardship efforts should standardize treatment of common infections when possible. Urinary tract infections (UTIs) are common in children and require appropriate diagnostic methods and treatment. A pediatric emergency department (ED) identified an opportunity to improve care by standardizing uncomplicated UTI diagnostic testing and treatment according to local bacterial resistance patterns from January 2017 to December 2018. Methods Using the Model for Improvement, researchers undertook a quality improvement (QI) initiative to standardize the diagnosis and treatment of uncomplicated UTI in children ages 3 months to 12 years in a pediatric ED. Multiple Plan-Do-Study-Act (PDSA) cycles were used, engaging both nurses and physicians, to implement an evidence-based clinical algorithm. Primary aims were to achieve 100% of targeted patients with suspected UTI having appropriately ordered and collected specimens and to increase the frequency of targeted patients receiving algorithm-recommended antibiotics at discharge to 80%. Balancing measures included ED length of stay and revisits to the ED related to UTI. Results During this initiative, 458 children were assessed for UTI, of whom 75 received a UTI diagnosis. Guideline-concordant urine collection procedure improved from 54.7% to 96.2%. After project initiation, 100% of all antibiotic prescriptions for UTI were guideline-concordant. These changes have been sustained for 19 months since the initiative began. There was no change in UTI–related ED revisits or ED length of stay. Conclusions This QI initiative achieved standardization of specimen collection and treatment for pediatric UTI in the ED setting, and no adverse outcomes were observed at the institution. |
| Databáze: | OpenAIRE |
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