PM2034: Implementing Strategies to Address the Common Misusage of Antibiotics in Children

Purpose/Objectives: To utilize the BASiC framework at a small academic children’s hospital and develop interventions to achieve evidence-based antibiotic selection and duration of treatment for 85-90% of pediatric CAP, SSTI, and UTI at our institution.

Design/Methods: Baseline data was collected via chart review from children ages 2 months to 18 years old without a complex medical history seen in the ED or admitted to the inpatient setting for CAP, SSTI, or UTI from July 2019-April 2021. Quality improvement interventions occurred following baseline data collection, and included resident and faculty education on recommended treatment duration (cycle 23) and creation of order sets within our EMR (cycle 27) to guide empiric antibiotic therapies for each diagnosis. Post-intervention charts were then reviewed from May 2021-December 2021 on a monthly basis (cycles).

Results: Figure 1a and 1c show that goal treatment duration at our facility for CAP and UTI < 24 months old was achieved and maintained following intervention with resident and faculty education in cycle 23. Figure 1b demonstrates the largest and most consistent improvement in goal treatment duration was achieved for SSTI following intervention, whereas the target goal had not been met in any prior baseline cycle. Empiric antibiotic selection for CAP (Figure 2a) has not yet been impacted by initiation of an order set. Figure 2b shows empiric SSTI antibiotic choices were already above goal of 85% at baseline and still remained above goal after intervention with order sets in cycle 27. Empiric antibiotic selection for UTI was able to meet goal for the first time after initiation of pre-selected antibiotic order sets in cycle 27, whereas this goal had not been met in any previous cycles as demonstrated in Figure 2c. Interventions did not cause any increase over baseline data in length of stay, readmissions, and transfers to a higher level of care.

Conclusion/Discussion: Resident and faculty education and creation of order sets can be effective means of improving empiric antibiotic selection and duration of treatment for pediatric CAP, SSTI, and UTI. Slow improvement in empiric antibiotic choice was impacted by antibiotic administration at outside hospitals prior to transfer to our children’s hospital. Dissemination of these interventions to surrounding clinics and referral hospitals may further improve antibiotic usage at our institution. In addition, the small number of cases seen at our facility and limited cycles following intervention strategies could also impact our overall data. Extending the implementation period could demonstrate ongoing improvements.