How one hospital eliminated inappropriate antibiotic prescriptions

Program rose adherence with guidelines to 100%

Cincinnati Children's Hospital Medical Center eliminated nearly all inappropriate antibiotic prescriptions to children diagnosed with pneumonia in just six months by implementing a simple quality improvement program, according to a study in Pediatrics.

For the study, researchers at the University of Cincinnati's College of Medicine implemented a quality improvement program at the pediatric hospital in an effort to bring physician prescribing practices for children diagnosed with community-acquired pneumonia in line with national guidelines.

The 2011 guidelines—issued by the Pediatric Infectious Disease Society and the Infectious Diseases Society of America—recommend that doctors prescribe the antibiotic ampicillin before prescribing broad spectrum antibiotics in an effort to reduce strains of the disease that are resistant to broad spectrum drugs.

The quality improvement program consisted of:

  • Creating a quick reference guide of the new antibiotic prescribing rules for residents;
  • Educating senior-level physicians on the new rules; and
  • Updating the hospital's electronic health record system to default to the guidelines.

The researchers began tracking patients' treatment six months before the changes were implemented and for nine months after. During the 12-month period, 217 kids were treated for pneumonia at the hospital.

Prior to introducing the program, the researchers found doctors rarely adhered to the national guidelines. Specifically, ED doctors almost never adhered to the prescribing guidelines, while other physicians in the hospital adhered to the guidelines about 30% of the time.

The researchers saw adherence jump to 80% immediately after implementing the changes, and they continued to increase ultimately reaching 100% adherence within six months (Grens, Reuters, 4/17).

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