A Collaborative Multicenter QI Initiative to Improve Antibiotic Stewardship in Newborns

Dmitry Dukhovny, Madge E Buus-Frank, Erika M Edwards, Timmy Ho, Kate A Morrow, Arjun Srinivasan, Daniel A Pollock, John A F Zupancic, DeWayne M Pursley, Donald Goldmann, Karen M Puopolo, Roger F Soll, Jeffrey D Horbar
Pediatrics 2019, 144 (6)

OBJECTIVES: To determine if NICU teams participating in a multicenter quality improvement (QI) collaborative achieve increased compliance with the Centers for Disease Control and Prevention (CDC) core elements for antibiotic stewardship and demonstrate reductions in antibiotic use (AU) among newborns.

METHODS: From January 2016 to December 2017, multidisciplinary teams from 146 NICUs participated in Choosing Antibiotics Wisely, an Internet-based national QI collaborative conducted by the Vermont Oxford Network consisting of interactive Web sessions, a series of 4 point-prevalence audits, and expert coaching designed to help teams test and implement the CDC core elements of antibiotic stewardship. The audits assessed unit-level adherence to the CDC core elements and collected patient-level data about AU. The AU rate was defined as the percentage of infants in the NICU receiving 1 or more antibiotics on the day of the audit.

RESULTS: The percentage of NICUs implementing the CDC core elements increased in each of the 7 domains (leadership: 15.4%-68.8%; accountability: 54.5%-95%; drug expertise: 61.5%-85.1%; actions: 21.7%-72.3%; tracking: 14.7%-78%; reporting: 6.3%-17.7%; education: 32.9%-87.2%; P < .005 for all measures). The median AU rate decreased from 16.7% to 12.1% ( P for trend < .0013), a 34% relative risk reduction.

CONCLUSIONS: NICU teams participating in this QI collaborative increased adherence to the CDC core elements of antibiotic stewardship and achieved significant reductions in AU.

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