NICU quality improvement initiative reduced vancomycin treatment


New exploration review shows 66{bf9f37f88ebac789d8dc87fbc534dfd7d7e1a7f067143a484fc5af4e53e0d2c5} reduction in vancomycin use in clients, improved client outcomes

July 01, 2020

A quality enhancement initiative in the Neonatal Intense Care Unit (NICU) at Children’s National Healthcare facility led to a considerable reduction in therapy with intravenous vancomycin, an antibiotic utilized for resistant gram optimistic bacterial infections, which is frequently involved with acute kidney damage. The results, revealed in the journal Pediatrics, show the initiative diminished vancomycin use in clients by 66{bf9f37f88ebac789d8dc87fbc534dfd7d7e1a7f067143a484fc5af4e53e0d2c5}, and the NICU has sustained the reduction for far more than a calendar year. 

Vancomycin is a broad-spectrum antibiotic frequently utilized to treat methicillin-resistant Staphylococcus aureus (MRSA) infection. It’s one particular of the most commonly prescribed antibiotics in NICUs, but its overuse poses an greater hazard of morbidity. Benchmarking facts confirmed that in 2017, vancomycin use at Children’s National Healthcare facility was appreciably better than use at peer institutions, suggesting there was most likely an prospect to improve use of this drug.

The intervention system was led by Rana Hamdy, M.D., M.S.C.E., M.P.H., an infectious illnesses expert at Children’s National, Lamia Soghier, M.D., professional medical unit director of the Children’s National NICU, and other crew users from neonatology, infectious illnesses, pharmacy, nursing and quality enhancement. The crew attained the perscribing reduction by sequentially employing a 4-action method involving interdisciplinary crew developing and provider training, pharmacist-initiated forty eight-hour time-outs, medical pathway progress and prospective audit with comments.

“Our interdisciplinary quality enhancement crew was devoted to this undertaking and implemented interventions that, early on, led not only to reduction in vancomycin use, but to superior outcomes in our clients with much less episodes of vancomycin-involved acute kidney damage,” claimed Dr. Hamdy. “This led to early get-in from the prescribers, eventually transforming the tradition of antibiotic prescribing in the NICU.”

Pursuing the NICU’s intervention system to increase client protection, vancomycin use in clients decreased from 112 times of treatment for every 1,000 client-times to 38 times of treatment for every 1,000 client-times. During the intervention system, the researchers pointed out that this was “the to start with perform to show a considerable adjust in vancomycin-involved acute kidney damage in neonates.”

4 essential interventions ended up sequentially implemented to efficiently reach and maintain the reduction in vancomycin use. Intervention 1 was the progress of an interdisciplinary and provider training crew that dealt with institutional antibiotic prescribing techniques. Intervention 2, a pharmacist-initiated forty eight-hour time-out, involved medical pharmacists pinpointing clients who have been on antibiotics for ≥ forty eight several hours and encouraged their suppliers to possibly discontinue vancomycin or to switch to a slim-spectrum antibiotic. Intervention 3 consisted of the progress of new medical pathways including discontinuing vancomycin in infants at low-hazard for MRSA. Last of all, intervention 4, antimicrobial stewardship system (ASP) prospective audit and comments, involved an ASP member reviewing all NICU vancomycin orders and issuing appropriate suggestions for NICU suppliers and pharmacists to be carried out inside of 24 several hours. 

This undertaking was taken on as aspect of Children’s National Good quality Advancement and Management Schooling (QuILT) training course sponsored by the Good quality & Safety Department. This noteworthy perform was highlighted in the 2019 once-a-year Good quality and Safety report and by the Magnet system as an exemplary illustration of nursing-health practitioner partnership doing the job to increase client care. 

The involved report, “Reducing Vancomycin Use in a Level IV Neonatal Intense Care Unit,” will be revealed July 1 in Pediatrics. The guide writer is Dr. Rana Hamdy, an infectious illnesses expert and director of the Antimicrobial Stewardship System. Twenty noteworthy co-authors are also from Children’s National. 

Media Speak to: Jamel Langley | (850) 212-5342 | (301) 244-6731

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