A Quality Improvement Initiative To Improve Postdischarge Antimicrobial Adherence
| Autor: | Brittany Le, Jennifer McCarthy, Marco Costilla, Amanda Broderick, Katherine French, Huay-ying Lo, Jeffrey L Wagner, Britanny Winckler, Michelle A. Lopez, Sheena Gupta |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Quality management Adolescent MEDLINE Aftercare Directive Counseling Pharmacy Run chart Drug Administration Schedule Medication Adherence 03 medical and health sciences 0302 clinical medicine Anti-Infective Agents 030225 pediatrics Medicine Humans Medical prescription Child Process Measures business.industry Infant Newborn Infant Antimicrobial Hospitals Pediatric Quality Improvement Texas Caregivers Child Preschool Pediatrics Perinatology and Child Health Emergency medicine Female business Pharmacy Service Hospital |
| Zdroj: | Pediatrics. 147(1) |
| ISSN: | 1098-4275 |
| Popis: | OBJECTIVES: Bedside delivery of discharge medications improves caregiver understanding and experience. Less is known about its impact on medication adherence. We aimed to improve antimicrobial adherence by increasing on-time first home doses for patients discharged from the pediatric hospital medicine service from 33% to 80% over 1 year via creation of a discharge medication delivery and counseling “Meds to Beds” (M2B) program. METHODS: Using sequential plan-do-study-act cycles, an interprofessional workgroup implemented M2B on select pediatric hospital medicine units at our quaternary children’s hospital from October 2017 through December 2018. Scripted telephone surveys were conducted with caregivers of patients prescribed antimicrobial agents at discharge. The primary outcome measure was on-time administration of the first home antimicrobial dose, defined as a dose given within the time of the inpatient dose equivalent plus 25%. Process measures primarily assessed caregiver report of barriers to adherence. Run charts, statistical process control charts, and inferential statistics were used for data analysis. RESULTS: Caregiver survey response rate was 35% (207 of 585). Median on-time first home antimicrobial doses increased from 33% to 67% (P < .001). Forty percent of M2B prescriptions were adjusted before discharge because of financial or insurance barriers. M2B participants reported significantly less difficulty in obtaining medications compared with nonparticipants (1% vs 17%, P < .001). CONCLUSIONS: The M2B program successfully increased parental report of timely administration of first home antimicrobial doses, a component of overall adherence. The program enabled providers to identify and resolve prescription problems before discharge. Importantly, caregivers reported reduced barriers to medication adherence. |
| Databáze: | OpenAIRE |
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