Reducing Antibiotic Prescription Errors in the Emergency Department: A Quality Improvement Initiative

Kasmire, Kathryn E.; Cerrone, Crista; Hoppa, Eric

doi:10.1097/pq9.0000000000000314

Cited by 3 publications

(2 citation statements)

References 25 publications

(17 reference statements)

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“…An intervention at a pediatric facility introduced antibiotic-order panels for urinary tract infections (UTIs) and skin and soft tissue infections into the system's EHR. 35 These panels could be accessed by entering the diagnosis, and prepopulated the correct antibiotic, dosage, dosing interval, and duration of prescription therapy. These discharge panels were found to improve the prescribing of appropriate treatment durations.…”

Section: Prepopulated Antibiotic Optionsmentioning

confidence: 99%

Use of the Electronic Health Record to Optimize Antimicrobial Prescribing

Parzen-Johnson

Kronforst

Shah

et al. 2021

Clinical Therapeutics

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Section: Prepopulated Antibiotic Optionsmentioning

confidence: 99%

Use of the Electronic Health Record to Optimize Antimicrobial Prescribing

Parzen-Johnson

Kronforst

Shah

et al. 2021

Clinical Therapeutics

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“…Still, few studies focus on pediatric primary care. 7 In 2018, over 2000 primary care patients at our organization were given antimicrobials for treating UTIs, including cystitis and pyelonephritis. Trimethoprimsulfamethoxazole was prescribed for thirty-three percent of patients.…”

Section: Introductionmentioning

confidence: 99%

Utilizing Clinical Decision Support in the Treatment of Urinary Tract Infection across a Large Pediatric Primary Care Network

Karas

Upadhyayula

Love

et al. 2023

Pediatric Quality &Amp; Safety

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Introduction: Cystitis and pyelonephritis are common bacterial infections in infants and children, and initial treatment is usually empirical. Antimicrobial stewardship advocates using narrow-spectrum antibiotics with consideration for local resistance patterns. Narrow-spectrum antibiotic use is critical in addressing the global issue of bacterial antimicrobial resistance, associated with approximately 5 million annual deaths. Methods: The antimicrobial stewardship committee developed a guideline for diagnosing and managing urinary tract infections and distributed it to all primary care providers. A standardized order set provided clinical decision support regarding appropriate first-line antibiotic therapy. A chief complaint of dysuria prompted the use of the order set. Prescription rates for the most common antimicrobials were tracked on a control chart. Results: From March 2018 through March 2020, there were 4,506 antibiotic prescriptions for urinary tract infections. Utilization of the recommended first-line therapy, cephalexin, increased from 27.5% to 74.8%. Over the same period, trimethoprim-sulfamethoxazole, no longer recommended due to high local resistance, decreased from 31.8% to 8.1%. Providers have maintained these prescribing patterns since the conclusion of the project. Conclusion: Using clinical decision support as a standardized order set can sustainably improve the use of first-line antimicrobials for treating pediatric urinary tract infections.

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A National Quality Improvement Collaborative to Improve Antibiotic Use in Pediatric Infections

McCulloh,

Kerns,

Flores

et al. 2024

Pediatrics

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BACKGROUND: Nearly 25% of antibiotics prescribed to children are inappropriate or unnecessary, subjecting patients to avoidable adverse medication effects and cost. METHODS: We conducted a quality improvement initiative across 118 hospitals participating in the American Academy of Pediatrics Value in Inpatient Pediatrics Network 2020 to 2022. We aimed to increase the proportion of children receiving appropriate: (1) empirical, (2) definitive, and (3) duration of antibiotic therapy for community-acquired pneumonia, skin and soft tissue infections, and urinary tract infections to ≥85% by Jan 1, 2022. Sites reviewed encounters of children >60 days old evaluated in the emergency department or hospital. Interventions included monthly audit with feedback, educational webinars, peer coaching, order sets, and a mobile app containing site-specific, antibiogram-based treatment recommendations. Sites submitted 18 months of baseline, 2-months washout, and 10 months intervention data. We performed interrupted time series (analyses for each measure. RESULTS: Sites reviewed 43 916 encounters (30 799 preintervention, 13 117 post). Overall median [interquartile range] adherence to empirical, definitive, and duration of antibiotic therapy was 67% [65% to 70%]; 74% [72% to 75%] and 61% [58% to 65%], respectively at baseline and was 72% [71% to 72%]; 79% [79% to 80%] and 71% [69% to 73%], respectively, during the intervention period. Interrupted time series revealed a 13% (95% confidence interval: 1% to 26%) intercept change at intervention for empirical therapy and a 1.1% (95% confidence interval: 0.4% to 1.9%) monthly increase in adherence per month for antibiotic duration above baseline rates. Balancing measures of care escalation and revisit or readmission did not increase. CONCLUSIONS: This multisite collaborative increased appropriate antibiotic use for community-acquired pneumonia, skin and soft tissue infections, and urinary tract infection among diverse hospitals.

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Reducing Antibiotic Prescription Errors in the Emergency Department: A Quality Improvement Initiative

Abstract: Supplemental Digital Content is available in the text.

Cited by 3 publications

References 25 publications

Use of the Electronic Health Record to Optimize Antimicrobial Prescribing

Use of the Electronic Health Record to Optimize Antimicrobial Prescribing

Utilizing Clinical Decision Support in the Treatment of Urinary Tract Infection across a Large Pediatric Primary Care Network

A National Quality Improvement Collaborative to Improve Antibiotic Use in Pediatric Infections

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