Improving intravenous-to-oral antibiotic switch in children: a team-based audit and implementation approach

Improving intravenous-to-oral antibiotic switch in children: a team-based audit and implementation approach

Children in hospital are frequently prescribed intravenous antibiotics for longer than needed. Programmes to optimise timely intravenous-to-oral antibiotic switch may limit excessive in-hospital antibiotic use, minimise complications of intravenous therapy and allow children to go home faster. Here,...

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Bibliographic Details
Published in:BMJ open quality Vol. 10; no. 1; p. e001120
Main Authors: McMullan, Brendan Joseph, Mahony, Michelle, Java, Lolita, Mostaghim, Mona, Plaister, Michael, Wu, Camille, White, Sophie, Al Yazidi, Laila, Martin, Erica, Bryant, Penelope, Thursky, Karin A, Buono, Evette
Format: Journal Article
Language:English
Published: England BMJ Publishing Group LTD 01-03-2021
BMJ Publishing Group
Subjects:
Abscesses
Adults
Antibiotics
Antimicrobial agents
Appendicitis
Audits
Cellulitis
Drug stores
Education
Feedback
Health administration
Hospitals
Infections
Infectious diseases
Intravenous therapy
Medical records
Patients
Pediatrics
Pharmacy
Pneumonia
Quality control
Quality improvement
Quality Improvement Report
Systematic review
Teams
paediatrics
audit and feedback
teamwork
healthcare quality improvement
antibiotic management
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Summary:Children in hospital are frequently prescribed intravenous antibiotics for longer than needed. Programmes to optimise timely intravenous-to-oral antibiotic switch may limit excessive in-hospital antibiotic use, minimise complications of intravenous therapy and allow children to go home faster. Here, we describe a quality improvement approach to implement a guideline, with team-based education, audit and feedback, for timely, safe switch from intravenous-to-oral antibiotics in hospitalised children. Eligibility for switch was based on evidence-based guidelines and supported by education and feedback. The project was conducted over 12 months in a tertiary paediatric hospital. Primary outcomes assessed were the proportion of eligible children admitted under paediatric and surgical teams switched within 24 hours, and switch timing prior to and after guideline launch. Secondary outcomes were hospital length of stay, recommencement of intravenous therapy or readmission. The percentage of children switched within 24 hours of eligibility significantly increased from 32/50 (64%) at baseline to 203/249 (82%) post-implementation (p=0.006). The median time to switch fell from 15 hours 42 min to 4 hours 20 min (p=0.0006). In addition, there was a 14-hour median reduction in hospital length of stay (p=0.008). Readmission to hospital and recommencement of intravenous therapy did not significantly change postimplementation. This education, audit and feedback approach improved timely intravenous-to-oral switch in children and also allowed for more timely discharge from hospital. The study demonstrates proof of concept for this implementation with a methodology that can be readily adapted to other paediatric inpatient settings.
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ISSN:2399-6641
2399-6641
DOI:10.1136/bmjoq-2020-001120