Quality improvement methods increase adherence to pediatric pneumonia treatment guidelines

Image: PD. Streptococcus pneumoniae

Neha Joshi and Leah H. Carr
Reviewed by Dr. William V. Raszka, MD

1. Quality improvement (QI) methods were effective in improving the appropriate first-line antibiotic prescribing for inpatient pediatric community-acquired pneumonia (CAP). 

2. Adherence to national guidelines for antibiotic prescribing increased to 100% in both the emergency department (ED) and pediatric inpatient service within 6 months. 

Study Rundown: CAP is a common, critical infection among pediatric patients, leading to over 150,000 hospitalizations in the United States each year. In 2011, the Pediatric Infectious Disease Society and Infectious Disease Society of America released guidelines for the management of CAP in children, suggesting that first-line antibiotic therapy include (1) amoxicillin or ampicillin, (2) ceftriaxone, cefdinir, or clindamycin in cases of penicillin allergy, or (3) azithromycin on day 1 in combination with amoxicillin or ampicillin. This study examined QI methods at a tertiary children’s hospital to increase adherence to national guidelines for appropriate first-line antibiotic prescribing. Over 6 months, guideline adherence in the ED and on inpatient pediatric hospitalist teams increased to 100%. Limitations to this study included interventions designed for a large teaching institution with an electronic medical record system that would need to be modified for smaller, community-based hospitals and those with different charting systems. These findings suggest that adherence to national guidelines for pediatric inpatient CAP management can be quickly and effectively improved through QI methods.

Click to read the study, released today in Pediatrics

Relevant Reading: The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and Infectious Diseases Society of America

Study Author, Dr. Lilliam Ambroggio, PhD MPH, speaks to 2 Minute Medicine: 

“Our study uses quality improvement methods to rapidly improve prescription adherence to the recently published PIDS/IDSA national guideline for community-acquired pneumonia (CAP). We improved appropriate first-line antibiotic therapy to 100 percent in both the emergency department and hospital medicine settings. Prior to implementation of the new national guideline, otherwise healthy children with CAP were treated and prescribed medications for their conditions as based on an institution specific evidence-based guideline CCHMC issued in 2006. Cincinnati Children Hospital Medical Center is committed to adopting the best available evidence to improve the quality of patient care.”

In-Depth [quality improvement study]: This study examined the utilization of QI methods to increase adherence to national guidelines for treatment of CAP in an inpatient pediatric population at a large, tertiary-care academic center. Chart review was used to assess antibiotic prescription patterns prior to intervention. Four drivers were identified  to achieve the study goals: increased provider buy-in, effective communication between care providers, accurate knowledge of guidelines, and accurate order entry. Interventions were implemented in both the ED and on the pediatric hospital medicine teams following a seminar on proper prescribing guidelines. The interventions included staff training, pocket cards for physicians and charge nurses, and an updated template and order set in the electronic medical record system. The study included 217 patients diagnosed with CAP. Adherence rates increased from 0% to 100% in the ED, and from 30% to 100% on pediatric hospital medicine teams within 6 months, and were sustained for 3 months following the study’s conclusion. The most significant improvement in adherence, from 0% to 82% in the ED and 30% to 90% on pediatric hospital medicine teams, occurred following formal seminar instruction and a handout on national guidelines. Further increases, to 100% in both departments, were attributed to the remaining interventions.

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