Quality improvement program tries to reduce vancomycin use

The drive to reduce antibiotic resistance has led to reduce the use of commonly prescribed antibiotics such as vancomycin. A report in Pediatrics examines whether a quality improvement initiative could change how 1 neonatal intensive care unit (NICU) prescribed vancomycin.¹

Investigators created a quality improvement framework that included physician education that involved benchmarking for antibiotic prescribing rates; pharmacy-initiated 48-hour antibiotic time-outs on rounds; developing clinical pathways to standardize empirical antibiotic choices for certain situations such as necrotizing enterocolitis; and a daily audit that included feedback from an antimicrobial stewardship program. The program was deployed in a 60-bed level IV NICU in an academic referral center.

Statistical process u-charts were used to indicate that the use of vancomycin had declined from 112 to 38 days of therapy per 1000 patient-days. Following education, development of clinical pathways, and pharmacy-initiated 48-hour time-outs, the use of vancomycin declined by 29%. It declined by an additional 52% when it implemented the daily audit. They also found that acute kidney injury associated with vancomycin declined from 1.4 to 0.1 events per 1000 patient-days.

The researchers concluded that the implemented quality improvement program led to a decline in the use of vancomycin over a year and the decline was maintained over another year.

Reference

1. Hamdy R, Bhattarai S, Basu S et al. Reducing vancomycin use in a level IV NICU. Pediatrics. 2020:145(6):e20192963. doi:10.1542/peds.2019-2963