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Improving intravenous-to-oral antibiotic switch in children: a team-based audit and implementation approach. | LitMetric

AI Article Synopsis

  • Children in hospitals often get kept on intravenous antibiotics longer than necessary, which can lead to complications and longer stays; switching to oral antibiotics when appropriate can help shorten hospital durations.* -
  • A quality improvement project was conducted over 12 months, using team education and feedback to successfully implement guidelines for switching from intravenous to oral antibiotics in hospitalized children.* -
  • Results showed a significant increase in the percentage of eligible children switched to oral antibiotics within 24 hours (from 64% to 82%), reduced time to switch, and a 14-hour decrease in hospital stay, with no increase in readmission or need for intravenous therapy afterward.*

Article Abstract

Children in hospital are frequently prescribed intravenous antibiotics for longer than needed. Programmes to optimise timely intravenous-to-oral antibiotic switch may limit excessive in-hospital antibiotic use, minimise complications of intravenous therapy and allow children to go home faster. Here, we describe a quality improvement approach to implement a guideline, with team-based education, audit and feedback, for timely, safe switch from intravenous-to-oral antibiotics in hospitalised children. Eligibility for switch was based on evidence-based guidelines and supported by education and feedback. The project was conducted over 12 months in a tertiary paediatric hospital. Primary outcomes assessed were the proportion of eligible children admitted under paediatric and surgical teams switched within 24 hours, and switch timing prior to and after guideline launch. Secondary outcomes were hospital length of stay, recommencement of intravenous therapy or readmission. The percentage of children switched within 24 hours of eligibility significantly increased from 32/50 (64%) at baseline to 203/249 (82%) post-implementation (p=0.006). The median time to switch fell from 15 hours 42 min to 4 hours 20 min (p=0.0006). In addition, there was a 14-hour median reduction in hospital length of stay (p=0.008). Readmission to hospital and recommencement of intravenous therapy did not significantly change postimplementation. This education, audit and feedback approach improved timely intravenous-to-oral switch in children and also allowed for more timely discharge from hospital. The study demonstrates proof of concept for this implementation with a methodology that can be readily adapted to other paediatric inpatient settings.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7978100PMC
http://dx.doi.org/10.1136/bmjoq-2020-001120DOI Listing

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