Reducing Vancomycin Use in a Level IV NICU

Reducing Vancomycin Use in a Level IV NICU

BACKGROUND AND OBJECTIVES: Vancomycin remains one of the most commonly prescribed antibiotics in NICUs despite recommendations to limit its use for known resistant infections. Baseline data revealing substantially higher vancomycin use in our NICU compared to peer institutions informed our quality i...

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Bibliographic Details
Published in:Pediatrics (Evanston) Vol. 146; no. 2; p. 1
Main Authors: Hamdy, Rana F., Bhattarai, Sopnil, Basu, Sudeepta K., Hahn, Andrea, Stone, Brian, Sadler, Eleanor D., Hammer, Benjamin M., Galiote, John, Slomkowski, Julie, Casto, Anne M., Korzuch, Katelyn P., Chase, Hannah, Nzegwu, Nneka, Greenberg, Isabella, Ortiz, Noelle, Blake, Carmen, Chang, Jaeho, Bost, James E., Payne, Asha S., Shah, Rahul K., Soghier, Lamia
Format: Journal Article
Language:English
Published: Evanston American Academy of Pediatrics 01-08-2020
Subjects:
Age
Antibiotics
Company business management
Diseases
Dosage and administration
Drug therapy
Enterocolitis
Evaluation
Feedback
Infants (Newborn)
Intensive care
Management
Medical care
Medical care quality
Medical care utilization
Necrotizing enterocolitis
Neonatal care
Neonatal diseases
Neonatal intensive care units
Neonates
Pediatrics
Pharmacy
Quality control
Quality management
Sepsis
Standardization
Utilization
Vancomycin
United States
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Summary:BACKGROUND AND OBJECTIVES: Vancomycin remains one of the most commonly prescribed antibiotics in NICUs despite recommendations to limit its use for known resistant infections. Baseline data revealing substantially higher vancomycin use in our NICU compared to peer institutions informed our quality improvement initiative. Our aim was to reduce the vancomycin prescribing rate in neonates hospitalized in our NICU by 50% within 1 year and sustain for 1 year. METHODS: In the 60-bed level IV NICU of an academic referral center, we used a quality improvement framework to develop key drivers and interventions including (1) physician education with benchmarking antibiotic prescribing rates; (2) pharmacy-initiated 48-hour antibiotic time-outs on rounds; (3) development of clinical pathways to standardize empirical antibiotic choices for early-onset sepsis, late-onset sepsis, and necrotizing enterocolitis; coupled with (4) daily prospective audit with feedback from the antimicrobial stewardship program. RESULTS: We used statistical process u-charts to show vancomycin use declined from 112 to 38 days of therapy per 1000 patient-days. After education, pharmacy-initiated 48-hour time-outs, and development of clinical pathways, vancomycin use declined by 29%, and by an additional 52% after implementation of prospective audit with feedback. Vancomycin-associated acute kidney injury also declined from 1.4 to 0.1 events per 1000 patient-days. CONCLUSIONS: Through a sequential implementation approach of education, standardization of care with clinical pathways, pharmacist-initiated 48-hour time-outs, and prospective audit with feedback, vancomycin days of therapy declined by 66% over a 1-year period and has been sustained for 1 year.
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ISSN:0031-4005
1098-4275
DOI:10.1542/peds.2019-2963