218 - A QI Initiative To Reduce Prolonged Antibiotic Use In Two NICUs

Poster Number: 218
Publication Number: 218.127

Yassar Arain, Santa Clara Valley Medical Center, Santa Clara, CA, United States; Sudha Rani R. Narasimhan, Santa Clara Valley Medical Center, San Jose, CA, United States; Priya Jegatheesan, Santa Clara Valley Medical Center, San Jose, CA, United States; Angela Huang, Santa Clara Valley Medical Center, San Jose, CA, United States; Jacklyn Carlos, O'Connor Hospital, Milpitas, CA, United States; Machelnil Cormier, O’Connor Hospital, San Jose, CA, United States; Maria D. Ruiz, OCH, San Jose, CA, United States; Marian M. Adams, UCSF Benioff Children's Hospital San Francisco, San Jose, CA, United States; christina Anderson, Santa clara valley medical center, Sunnyvale, CA, United States; sonya MIsra, Stanford University School of Medicine, San Jose, CA, United States; Dongli Song, Stanford University School of Medicine, San Jose, CA, United States

Background: Prolonged and unnecessary antibiotic use in neonates remains a problem in the NICU setting. Approaching antibiotic stewardship by safely reducing antibiotic use may help mitigate potential harm in this vulnerable patient population.

Objective: To safely reduce prolonged antibiotic use in culture negative sepsis by 20% in two NICU centers by the end of a 12-month collaborative period. 

Design/Methods: Two county NICUs, Santa Clara Valley Medical Center (VMC) and O’Connor Hospital (OCH), in the California Perinatal Quality Care Collaborative participated in the Optimizing Antibiotic Stewardship in California NICUs (OASCN) collaborative, which “aims to reduce antibiotic utilization and address challenges with implementing stewardship”. OASCN participation consisted of a learning model utilizing telementoring video conferences amongst a multidisciplinary group with statewide participation. The QI initiative included a pre-QI period of (1/2020-12/2020), and OASCN collaborative participation period of (1/2021-12/2021). Adoption of an electronic-health record antibiotic order set limiting antibiotics for 48 hours occurred in July 2021. The outcome measure was the percent of culture negative infants receiving antibiotics for greater than 48 hours. The process measure was the usage of the EHR order set per month. Balancing measure was number of infants who were restarted on antibiotics within 3 days after stopping antibiotics by 48 hours. 

Results: Antibiotic usage rate (AUR) during the pre-QI period was 12.5% at VMC and 17% at OCH. AUR during the QI study period was 10% at VMC and 6% at OCH. During the pre-QI period, a total of 45 infants and 23 infants were started on antibiotics at VMC and OCH, respectively. Prolonged antibiotic use during this period was 82% at VMC and 65% at OCH. After beginning participation in the OASCN collaborative, prolonged antibiotic use decreased to 45% at VMC, and 31% at OCH. The number of unique patients the EHR order set was used on increased five-fold from July through November 2021. There were no infants who were restarted on antibiotics within 3 days after stopping antibiotics by 48 hours.Conclusion(s): Participation in the OASCN collaborative coupled with initiation of an enterprise-wide EHR order set was associated with 50% reduction in prolonged antibiotic exposure in culture-negative patients. Next steps include standardizing blood culture specimen volume, optimizing the specimen culture bottles for the neonatal population, and reducing duration of antibiotic use to 36 hours when cultures remain negative.
Prolonged Antibiotic Use Rate at VMC (1/2020 – 11/2021)
Prolonged Antibiotic Use Rate at OCH (1/2020-11/2021)