Pilot Program Cuts Pediatric Antibiotic Prescriptions

Study results presented at the 42nd Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC) indicate that a 6-month pilot antibiotic stewardship program initiated at a pediatric long-term care facility resulted in a 59% decrease in topical antibiotic use and an 83% decrease in orders for antibiotics without proper documentation.

The pilot program was initiated when the infection prevention team at Elizabeth Seton Pediatric Center in Yonkers, NY, observed that some antibiotics were being prescribed for prolonged periods and for indications that were not infection-related. The program was meant to improve antibiotic prescribing and reduce antibiotic-resistant infection risk in their vulnerable patients.

For the study, the investigators conducted monthly audits on all antibiotics ordered between April and September 2014, with support from Gordon Hutcheon, MD, Chief Medical Director, and Natalie Neu, MD, MPH, Director of the Pediatric Infectious Diseases Fellowship Program at Columbia University, and the infectious disease consulting physicians at Elizabeth Seton Pediatric Center. The study team met regularly to review data with physicians, pharmacists, nurses, and administrators and enlist staff support to reduce inappropriate antibiotic prescribing.

Other goals of the program were to decrease the rate of prescriptions without a documented indication and to reduce the use of the topical antibiotic mupirocin for non-infectious conditions, including skin rashes and abrasions. The program achieved both of these goals.

“Our children suffer from many chronic health conditions, and any way that we can reduce the potential for antibiotic resistance will be beneficial for them in the long run,” said Olivia Jackson, RN, the center’s infection control coordinator. “While this is a pilot program, it is clear that we can make a sizeable impact by getting our healthcare providers to really think about why they are prescribing antibiotics and whether they are necessary.”

The pilot program also included the incorporation of a barrier built into the center’s electronic medical record (EMR) system, requiring providers to document the specific condition dictating the need for an antibiotic. Prior to the use of the EMR system, providers at the center often did not document a reason for antibiotic prescriptions or did not discontinue treatment at the completion of an appropriate duration. Following the initiation of the EMR system with the antibiotic-prescribing barrier, the study team observed a substantial decline in antibiotic prescription rates.

“Poor antibiotic prescribing practices put patients at risk for super-resistant infections for which there are few treatment options,” said APIC 2015 President Mary Lou Manning, PhD, CRNP, CIC, FAAN, FNAP. “Antimicrobial resistance is one of the most pressing issues facing healthcare today, and programs that steward the correct use of antibiotics, such as the pilot program described in this abstract, are a vital strategy to protect our patients in the future.”