Operationalising outpatient antimicrobial stewardship to reduce system-wide antibiotics for acute bronchitis
| Autor: | Christianne L. Roumie, Ruth M. Kleinpell, Carol Callaway-Lane, Milner B. Staub, Todd Hulgan, Robert S. Dittus, Robin G Cooke, Lauren D Mitchell, Jacob Hathaway, Morgan Clouse Johnson |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Medicine (General) Quality management Quality Improvement Report Leadership and Management Psychological intervention quality improvement Antimicrobial Stewardship 03 medical and health sciences control charts/run charts 0302 clinical medicine R5-920 Intervention (counseling) Outpatients medicine Humans Outpatient clinic Antimicrobial stewardship 030212 general & internal medicine Practice Patterns Physicians' Bronchitis Veterans Affairs business.industry 030503 health policy & services Health Policy Public Health Environmental and Occupational Health medicine.disease Anti-Bacterial Agents Emergency medicine audit and feedback Stewardship antibiotic management PDSA 0305 other medical science business |
| Zdroj: | BMJ Open Quality, Vol 10, Iss 3 (2021) BMJ Open Quality |
| ISSN: | 2399-6641 |
| Popis: | BackgroundAntibiotics are not recommended for treatment of acute uncomplicated bronchitis (AUB), but are often prescribed (85% of AUB visits within the Veterans Affairs nationally). This quality improvement project aimed to decrease antibiotic prescribing for AUB in community-based outpatient centres from 65% to MethodsFrom January to December 2018, community-based outpatient clinics’ 6 months’ average of prescribed antibiotics for AUB and upper respiratory infections was 63% (667 of 1054) and 64.6% (314 of 486) when reviewing the last 6 months. Seven plan–do–study–act (PDSA) cycles were implemented by an interprofessional antimicrobial stewardship team between January 2019 and March 2020. Balancing measures were a return patient phone call or visit within 4 weeks for the same complaint. Χ2 tests and statistical process control charts using Western Electric rules were used to analyse intervention data.ResultsThe AUB antibiotic prescribing rate decreased from 64.6% (314 of 486) in the 6 months prior to the intervention to 36.8% (154 of 418) in the final 6 months of the intervention. No change was seen in balancing measures. The largest reduction in antibiotic prescribing was seen after implementation of PDSA 6 in which 14 high prescribers were identified and targeted for individualised reviews of encounters of patients with AUB with an antimicrobial steward.ConclusionsOperational implementation of successful stewardship interventions is challenging and differs from the traditional implementation study environment. As a nascent outpatient stewardship programme with limited resources and no additional intervention funding, we successfully reduced antibiotic prescribing from 64.6% to 36.8%, a reduction of 43% from baseline. The most success was seen with targeted education of high prescribers. |
| Databáze: | OpenAIRE |
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