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

2. 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

3. 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

4. PBPs

5. 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

6. What we did
A multidisciplinary team was formed by February 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

9. 13.3
5.1

10. 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 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%!

11. Gracias!