P0143 - Pneumonia Antibiotic Stewardship in a Children’s Hospital Pediatric Emergency Department: A Quality Improvement Project

Background:
Community-acquired pneumonia (CAP) is a common pediatric illness. Many studies have identified Streptococcus pneumonia as the most common pathogen in children. It is unnecessary to administer broad spectrum antibiotics to treat CAP and it leads to microbial resistance. There is significant provider-to-provider variation in antibiotic prescribing practices for suspected uncomplicated PNA. Inpatient and ambulatory clinical practice guidelines have been shown to decreased variation between providers and improve outcomes.

Objective:
Our primary objective is to increase the percentage of otherwise healthy pediatric patients > 3 months to 18 years of age admitted to the pediatric hospitalist unit at YNHCH with a diagnosis of suspected uncomplicated CAP who receive appropriate evidence-based first-line antibiotic therapy from 12.5% to 80% from January 1, 2020 to July 1, 2020 in the YNHCH Pediatric Emergency Department (PED).

Design/

Methods:
Our team completed a data analysis of patients evaluated in the PED and admitted to the inpatient hospitalist unit with a diagnosis of uncomplicated CAP six months prior to interventions to evaluate antibiotic utilization of uncomplicated CAP. Parenteral ampicillin was emphasized as the preferred first line antibiotic based on community prevalence and sensitivities. Providers who work routinely in the PED completed an antibiotic stewardship survey. Furthermore, we identified key drivers that would lead to appropriate use of parenteral ampicillin for this population (Figure 1). Using the Model for Improvement, PDSA cycles focus on dissemination of antibiogram and access to the new guideline to all providers (Figure 2). Survey results and antibiogram were shared via newsletter and in-person education. The main outcome measure is the percentage of parenteral ampicillin for uncomplicated pneumonia. The secondary objective is the percentage of parenteral third-generation cephalosporin (ceftriaxone).
Next steps include continuing education of PED staff and evidence-based guideline dissemination. We are currently collecting weekly data to inform PDSA cycles.

Results:
Prior to dissemination of the new evidence-based guideline, 12.5% of suspected uncomplicated CPA were treated with parenteral ampicillin. A run chart was created to track antibiotic prescribing patterns in the PED. (Figure 3a, 3b) At this time, utilization of penicillin and ceftriaxone for uncomplicated CAP has remained the same.

Conclusion:
Thus far, education and dissemination of antibiogram has not resulted in a change in practice. We hope that incorporation of YNHCH evidence-based guideline in EMR significantly increased utilization of appropriate parenteral ampicillin usage for uncomplicated CPA admitted to the hospital.