Antibiotic Stewardship (Choosing Antibiotics Wisely in the NICU) VON, CDC, Collaboration SJH and GSMC Antibiotic Stewardship Team

Our team Our Senior Sponsor: Mary Shepler, RN Amy Matheus, RN Alfonso Pantoja, MD Ann Rodriguez, RN Michelle Feinberg, MD Terry Beck-Curtis, RN Scott Sveum, PD Kim Stephens, RN Siying Zhang, PD Erin Smart, RN Sandy Frost, PD Jeanne Burks, NNP Catherine M. Davis, PD Amanda Duran, NNP Carolyn Tower, MS, CIC Christi Schernecke, NNP Diane Metzger Jamie Friedel, NNP Our Senior Sponsor: Mary Shepler, RN

Our SMART AIM In an effort to raise the quality of NICU care and safety, the NICU antimicrobial stewardship team will establish and promote appropriate antimicrobial utilization by selecting the correct agent, dose, and duration for the prevention and treatment of infections according to evidence-based practice. Through daily rounding, antimicrobial data review, and prescribing habits, the team will reduce the median Antibiotic Usage Rate (AUR) by 20% by September 2016

PBPs

Our Key Driver Document 2º Drivers 1º Drivers Senior leader support to the project ✓ Engage a multidisciplinary team ✓ Establishing transparency in reporting of antibiotic use Engage parents as team members Organizational commitment and culture AIM Implement and refine clinical practice guidelines that support optimal antibiotic treatment for EOS, LOS, NEC and surgical conditions ✓ For each condition address criteria for Dx and Rx with the correct antibiotic, dose and duration of treatment ✓ Eliminate overuse and misuse of antibiotics in the NICU Protocols for specific neonatal infections Pharmacy driven interventions to assure appropriate antibiotic Rx Appoint a pharmacy leader ✓ Require pre-approval of certain antibiotics Create forcing functions for a 24 hour “time-out” for antibiotics during rounds ✓ Regular reporting on antibiotic use and resistance Generate automated monthly reports for AUR✓ Monitor antibiotic prescribing with process and outcome measures

What we did A multidisciplinary team was formed by February 2016. The team met twice a month starting in March 2016 Mary Shepler, RN, SJH CNO accepted to be our senior sponsor After presenting the characteristics of our QI project , the SJH IRB provided us a letter of approval Guidelines for the treatment of Early Onset Sepsis (EOS) and Late Onset Sepsis (LOS) were developed by April 2016 and approved by the neonatology QA Committee in May 2016 Pharmacist implemented an “Antibiotic Time-Out” during daily multidisciplinary rounds starting in May 2016 Education of the nursing staff and providers about the guidelines was done in June 2016 A guideline for the use of antibiotics around the time of surgical procedures was developed by August 2016 Data collection tools developed by July 2016

13.3 5.1

Did we achieve our Aim? Our baseline AUR (10/15 – 2/16) was relatively low: 13.3/1000 patient days, compared with what it has been described in the literature (2.4% to 97.1% , Schulman, et al. Pediatrics. 2015 May;135(5):826-33) The census in our NICU was consistently high during the months of observation (average 837 monthly patient days), being July, so far, the busiest month in our new hospital Our current AUR (3/16 – 7/16), is 5.12/100 patient days and it represents a reduction of 61.5%!

Gracias!