Program Schedule

1218
Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS): A Quality Improvement (QI) Collaborative

Session: Oral Abstract Session: Hospital – associated Infections in Pediatric Patients
Friday, October 10, 2014: 2:30 PM
Room: The Pennsylvania Convention Center: 107-AB
Background: Antibiotics (ab) are commonly prescribed and overused drugs for hospitalized children.  This contributes to ab resistance and unnecessary costs.  The most efficient and effective methods for performing antimicrobial stewardship remain unknown. We established a QI collaborative among children’s hospitals that share ab data for benchmark purposes as a method to guide stewardship interventions.

Methods: Seven hospitals that provide data to the Pediatric Health Information Systems (PHIS) database formed the collaborative.  A survey was given to each hospital to assess resources, antimicrobial stewardship program (ASP) activities, and local barriers.  Initial benchmarking reports were provided to the hospitals on overall ab use, use of ampicillin for pneumonia, and anti-pseudomonal ab for appendicitis.  These reports compared each hospital to peer hospitals utilizing PHIS. Hospitals requested additional detailed reports in areas of ab use problems.  Hospitals developed key driver diagrams to describe the stewardship interventions to improve use. Reports from collaborating institutions were shared monthly via webinar.

Results:   Three hospitals had ASPs in existence for > 3 years, 2 < 1 year, and 2 were developing their ASP.  All programs except one had at least 1 FTE (range 0-2) dedicated to their ASP. 46 benchmark reports have been developed. The reports have led to the following stewardship interventions:  ampicillin use for community-acquired pneumonia, intravenous to oral switch program, rapid diagnostics to identify methicillin susceptible S. aureus to decrease clindamycin use, limiting testing for C. difficile and development of antibiotic use guidelines for pneumonia, osteomyelitis, cystic fibrosis, septic shock, appendicitis and neutropenic fever. 

Conclusion: A QI collaborative using benchmark data can help stewardship programs identify targets for interventions and share best practices.  Future work will evaluate the impact of these interventions on prescribing quality, clinical outcomes and costs.

Jason G Newland, MD1, Adam L. Hersh, MD, PhD2, Jeffrey S. Gerber, MD, PhD3, Georgann Meredith, RN, BSN, BS, CCRC4, Brian Lee, MPH, PhD1, Cary Thurm, PhD5, Talene A. Metjian, PharmD6, Jared Olson, PharmD7, Emily a. Thorell, MD, MSci8, Scott Weissman, MD9, Adam Brothers, PharmD10, Jennifer Goldman, MD1, Diana Yu, PharmD, BCPS1, Sameer Patel, MD, MPH11, Rupal Patel, PharmD12, Joshua Courter, PharmD13, David Haslam14, Kari Simonsen, MD15, Meera Varman, MD16, Robin Stec, PharmD17 and SHARPS Collaborative, (1)Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City, Kansas City, MO, (2)University of Utah School of Medicine, Salt Lake City, UT, (3)Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, (4)Pediatrics, Children's Mercy Hospital, Kansas City, MO, (5)Children's Hospital Association, Overland Park, KS, KS, (6)Department of Antimicrobial Stewardship, Children's Hospital of Philadelphia, Philadelphia, PA, (7)Primary Children's Hospital, Salt Lake City, UT, (8)Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, (9)Seattle Childrens Research Institute, Seattle, WA, (10)Seattle Children's Hospital, Seattle, WA, (11)Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, (12)Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, (13)Division of Pharmacy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (14)Infectious Disease, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (15)Pediatrics, Children's Hospital of Omaha and University of Nebraska Medical Center, Omaha, NE, (16)Pediatrics, Children's Hospital of Omaha and Creighton University, Omaha, NE, (17)Pharmacy, Children's Hospital of Omaha, Omaha, NE

Disclosures:

J. G. Newland, Pfizer: Grant Investigator, Grant recipient

A. L. Hersh, None

J. S. Gerber, None

G. Meredith, Pfizer: Grant Investigator, Grant recipient

B. Lee, None

C. Thurm, None

T. A. Metjian, None

J. Olson, None

E. A. Thorell, None

S. Weissman, None

A. Brothers, None

J. Goldman, None

D. Yu, None

S. Patel, Pfizer: Grant Investigator, Grant recipient

R. Patel, Pfizer: Grant Investigator, Grant recipient

J. Courter, None

D. Haslam, None

K. Simonsen, None

M. Varman, Pfizer: Grant Investigator, Grant recipient

R. Stec, None

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