P0152 - Stop it!: A Quality Improvement Project to Reduce Antibiotic Utilization in the Neonatal Intensive Care Unit

Background:
Antibiotic overuse is consistently identified as a major source of waste within healthcare; neonates are especially vulnerable with resultant altered microbiota with increased susceptibility to morbidities such as necrotizing enterocolitis, nosocomial infections, and increased mortality. Our unit previously successfully completed a 75% reduction in antibiotic utilization rate (AUR) through the introduction of the Early Onset Sepsis Risk Calculator in 2017. We wished to further lessen antibiotic overuse, with a SMART aim of reducing AUR by 60% from September 2019 to December 2020. Baseline data revealed the largest contribution (56%) to our AUR was empiric treatment of Early Onset Sepsis (EOS); treatment of culture-negative infection contributed to 6% of our AUR, and antibiotic use for other indications comprised the remaining 38% (see Figure 1, Pareto Chart). Therefore, we opted to focus our initial efforts on reducing empiric treatment of EOS.

Methodology:
Our Neonatal Intensive Care Unit is a community Level 3, 24 bed unit in an adult urban hospital within a large health network. We have 8 neonatologists, 12 mid-level practitioners, and serve an average of 4000 annual inborns. After creating a multidisciplinary antibiotic stewardship task force, our efforts focused on achieving initially attending and subsequently practitioner buy-in for reducing empiric EOS treatment duration from 48 hours to 36 hours, in accordance with the American Academy of Pediatrics 2018 Management of Early Onset Sepsis Policy Statement. Our PDSA cycles changed the way antibiotics are discussed on rounds, and our pharmacist, a key stakeholder in our task force, implemented a process change in how empiric EOS antibiotics are discontinued. We also partnered with an informatics specialist to pull electronic medical record data into a dynamic query that provides weekly antibiotic usage data.

Discussion:
Our initial PDSA cycles focused on a modifiable and sizable contributor to our unit’s AUR, and have yielded a robust and thus far, sustained, reduction in AUR (see Figure 2, Run Chart). We have recently achieved our target goal of a 60% reduction in AUR. However, our work has revealed multiple opportunities for further process standardization and improvement (e.g. limiting the number of antibiotic doses available within the antibiotic order set; adjusting existing records to better track blood culture timing; weekly review of antibiotic usage with the clinical team) that we believe will further reduce our AUR.

Conclusion:
Through implementing a change in empiric treatment of EOS in our unit, we were successfully able to reduce AUR by 60% with our initial PDSA cycles. Further PDSA cycles aimed at streamlining tracking of the timing of blood culture and antibiotic administration are ongoing.