Improving the Transition of Intravenous to Enteral Antibiotics in Pediatric Patients with Pneumonia or Skin and Soft Tissue Infections
| Autor: | Michael J. Tchou, Angela M. Statile, Maya Dewan, Ndidi Unaka, Maria N Sellas, Brianna Liberio, Joshua D Courter, Sonya Tang Girdwood, Lisa E. Herrmann |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Leadership and Management medicine.drug_class Antibiotics Psychological intervention Assessment and Diagnosis Enteral administration 03 medical and health sciences 0302 clinical medicine Anti-Infective Agents 030225 pediatrics Internal medicine medicine Humans Infusions Parenteral 030212 general & internal medicine Child Care Planning business.industry Soft Tissue Infections Health Policy Soft tissue Pneumonia General Medicine Length of Stay Hospitals Pediatric Antimicrobial medicine.disease Quality Improvement Anti-Bacterial Agents Hospital medicine Community-Acquired Infections Hospitalization Child Preschool Population study Administration Intravenous Female Fundamentals and skills business |
| Zdroj: | Journal of Hospital Medicine. 15:9-15 |
| ISSN: | 1553-5606 1553-5592 |
| DOI: | 10.12788/jhm.3253 |
| Popis: | BACKGROUND Despite national recommendations for early transition to enteral antimicrobials, practice variability has existed at our hospital. OBJECTIVE The aim of this study was to increase the proportion of enterally administered antibiotic doses for Pediatric Hospital Medicine patients aged >60 days admitted for uncomplicated community-acquired pneumonia or skin and soft tissue infections from 44% to 75% in eight months. METHODS This quality improvement study was conducted at a large, urban, academic children's hospital. The study population included Hospital Medicine patients aged >60 days with diagnoses of pneumonia or skin and soft tissue infections. Interventions included education on intravenous and enteral antibiotic charge differentials, documentation of transition plan, structured discussions of transition criteria, and real-time identification of failures with feedback. Our process measure was the total number of enteral antibiotic doses divided by all antibiotic doses in patients receiving enteral medications on the same day. An annotated statistical process control chart tracked the impact of interventions on the administration route of antibiotic doses over time. Additional outcome measures included antimicrobial costs per patient encounter using average wholesale prices and length of stay. RESULTS The percentage of enterally administered antibiotic doses increased from 44% to 80% within eight months. Antimicrobial costs per patient encounter and the associated standard deviation of costs for our target diagnoses decreased by 70% and 84%, respectively. Average length of stay did not change. CONCLUSIONS Standardized communication about criteria for transition from intravenous to enteral antibiotics can lead to earlier transitions for patients with pneumonia or skin and soft tissue infections, subsequently reducing costs and prescribing variability. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Plný text