Decreasing Antibiotic Use in a Community Neonatal Intensive Care Unit: A Quality Improvement Initiative

Abstract

Objective: In view of the excessive use of antibiotics in our neonatal intensive care unit (NICU), we launched a 5-year multidisciplinary quality improvement (QI) initiative in our NICU in 2018. We had set our aim of decreasing the antibiotic use rate (AUR) from 22 to 17%.

Study design: The QI initiative was conducted in our 53-bed level 3B NICU. We used the core elements of antibiotic stewardship and focused on improving gaps in knowledge by using updated standards of care and a multidisciplinary approach. Outcome measures included overall AUR in NICU. Statistical control chart (P chart) was used to plot the AUR data quarterly.

Results: The AUR demonstrated a decline at the onset, and at the end of the initiative the AUR demonstrated a sustained decline to 13.18%, a 40% decrease from the baseline AUR of 22%. The changes that were implemented included development of evidence-based guidelines for babies less than and greater than 35 weeks, daily antibiotic stewardship rounds, sepsis risk calculator, antibiotic stop orders (48-hour stop, 36-hour soft stop, and 36-hour hard stop), and periodic reviews.

Conclusion: Our multidisciplinary approach using all the core elements of an antibiotic stewardship program significantly decreased AUR in our NICU.

Key points: · Excessive use of antibiotics may cause harm to the infant's health.. · Indiscriminate use of antibiotics can lead to antibiotic resistance.. · Stewardship programs can significantly decrease AUR in NICUs..

Fig. 1

Driver diagram. AAP, American Academy of Pediatrics; CDC, Centers for Disease Control and Prevention; EMR, electronic medical record; NICU, neonatal intensive care unit; PDSA, Plan Do Study Act; PVHMC, Pomona Valley Hospital Medical Center; VON, Vermont Oxford Network.

Fig. 2

EOS guidelines for Infants 35 weeks or greater gestation. AAP, American Academy of Pediatrics; EOS, early-onset sepsis; GBS, group B streptococcus; IPA, intrapartum antibiotic; ROM, rupture of membrane.

Fig. 3

EOS guidelines for infants 34 ^6/7 or less gestation. AAP, American Academy of Pediatrics; CBC, complete blood count; EOS, early-onset sepsis; GBS, group B streptococcus; IAI, intra-amniotic infection; PROM, premature rupture of membranes; ROM, rupture of membrane.

Fig. 4

2019 early-onset sepsis calculator compliance 35 weeks or greater.

Fig. 5

Extra antibiotic dosages 35 weeks or greater 2019 to 2020.

Fig. 6

Early-onset sepsis treatment days 35 weeks or greater.

Fig. 7

Antibiotic use rate P chart.