• J Hosp Med · Jan 2020

    Improving the Transition of Intravenous to Enteral Antibiotics in Pediatric Patients with Pneumonia or Skin and Soft Tissue Infections.

    • Sonya C Tang Girdwood, Maria N Sellas, Joshua D Courter, Brianna Liberio, Michael J Tchou, Lisa E Herrmann, Maya L Dewan, Angela M Statile, and Ndidi I Unaka.
    • Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
    • J Hosp Med. 2020 Jan 1; 15 (1): 10-15.

    BackgroundDespite national recommendations for early transition to enteral antimicrobials, practice variability has existed at our hospital.ObjectiveThe aim of this study was to increase the proportion of enterally administered antibiotic doses for Pediatric Hospital Medicine patients aged >60 days admitted for uncomplicated community-acquired pneumonia or skin and soft tissue infections from 44% to 75% in eight months.MethodsThis quality improvement study was conducted at a large, urban, academic children's hospital. The study population included Hospital Medicine patients aged >60 days with diagnoses of pneumonia or skin and soft tissue infections. Interventions included education on intravenous and enteral antibiotic charge differentials, documentation of transition plan, structured discussions of transition criteria, and real-time identification of failures with feedback. Our process measure was the total number of enteral antibiotic doses divided by all antibiotic doses in patients receiving enteral medications on the same day. An annotated statistical process control chart tracked the impact of interventions on the administration route of antibiotic doses over time. Additional outcome measures included antimicrobial costs per patient encounter using average wholesale prices and length of stay.ResultsThe percentage of enterally administered antibiotic doses increased from 44% to 80% within eight months. Antimicrobial costs per patient encounter and the associated standard deviation of costs for our target diagnoses decreased by 70% and 84%, respectively. Average length of stay did not change.ConclusionsStandardized communication about criteria for transition from intravenous to enteral antibiotics can lead to earlier transitions for patients with pneumonia or skin and soft tissue infections, subsequently reducing costs and prescribing variability.

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