Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2013 May;131(5):e1623-31.
doi: 10.1542/peds.2012-2635. Epub 2013 Apr 15.

Quality improvement methods increase appropriate antibiotic prescribing for childhood pneumonia

Lilliam Ambroggio  1 , Joanna Thomson, Eileen Murtagh Kurowski, Joshua Courter, Angela Statile, Camille Graham, Brieanne Sheehan, Srikant Iyer, Samir S Shah, Christine M White
Affiliations
Comparative Study

Quality improvement methods increase appropriate antibiotic prescribing for childhood pneumonia

Lilliam Ambroggio et al. Pediatrics. 2013 May.

Abstract

Objective: In August 2011, the Pediatric Infectious Disease Society and Infectious Disease Society of America published an evidence-based guideline for the management of community-acquired pneumonia (CAP) in children ≥3 months. Our objective was to evaluate if quality improvement (QI) methods could improve appropriate antibiotic prescribing in a setting without a formal antimicrobial stewardship program.

Methods: At a tertiary children's hospital, QI methods were used to rapidly implement the Pediatric Infectious Disease Society/Infectious Disease Society of America guideline recommendations for appropriate first-line antibiotic therapy in children with CAP. QI interventions focused on 4 key drivers and were tested separately in the emergency department and on the hospital medicine resident teams, using multiple plan-do-study-act cycles. Medical records of eligible patients were reviewed weekly to determine the success of prescribing recommended antibiotic therapy. The impact of these interventions on our outcome was tracked over time on run charts.

Results: Appropriate first-line antibiotic prescribing for children admitted with the diagnosis of CAP increased in the emergency department from a median baseline of 0% to 100% and on the hospital medicine resident teams from 30% to 100% within 6 months of introducing the guidelines locally at Cincinnati Children's Hospital Medical Center and has been sustained for 3 months.

Conclusions: Our study demonstrates that QI methods can rapidly improve adherence to national guidelines even in settings without a formal antimicrobial stewardship program to encourage judicious antibiotic prescribing for CAP.

Keywords: antibiotic use; pediatric; pneumonia.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Process map of antibiotic prescribing for a patient being admitted for CAP. Amox amoxicillin; PNA, pneuomonia.
FIGURE 2
FIGURE 2
Key driver diagram summarizing the project aim and interventions implemented to achieve the study aim. H&P, history and physical examination note; LOR, level of reliability.
FIGURE 3
FIGURE 3
Run chart for appropriate first-line antibiotic prescribing for CAP in the ED.
FIGURE 4
FIGURE 4
Run chart for appropriate first-line antibiotic prescribing for CAP on the HM resident teams.
None
See this image and copyright information in PMC

References

    1. Kronman MP, Hersh AL, Feng R, Huang YS, Lee GE, Shah SS. Ambulatory visit rates and antibiotic prescribing for children with pneumonia, 1994–2007. Pediatrics. 2011;127(3):411–418 - PMC - PubMed
    1. Lee GE, Lorch SA, Sheffler-Collins S, Kronman MP, Shah SS. National hospitalization trends for pediatric pneumonia and associated complications. Pediatrics. 2010;126(2):204–213 - PMC - PubMed
    1. Bradley JS, Byington CL, Shah SS, et al. Pediatric Infectious Diseases Society and the Infectious Diseases Society of America . The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):e25–e76 - PMC - PubMed
    1. Ambroggio L, Tabb LP, O’Meara T, Sheffler-Collins S, McGowan KL, Shah SS. Influence of antibiotic susceptibility patterns on empiric antibiotic prescribing for children hospitalized with community-acquired pneumonia. Pediatr Infect Dis J. 2012;31(4):331–336 - PMC - PubMed
    1. Brogan TV, Hall M, Williams DJ, et al. . Variability in processes of care and outcomes among children hospitalized with community-acquired pneumonia. Pediatr Infect Dis J. 2012;31(10):1036–1041 - PMC - PubMed

Publication types

MeSH terms

Substances