Using Electronic Health Record Tools to Decrease Antibiotic Exposure in Infant Sepsis Evaluation. Hosp Pediatr 2021 Sep;11(9):936-943
Date
08/15/2021Pubmed ID
34389551DOI
10.1542/hpeds.2021-005883Scopus ID
2-s2.0-85179549359 (requires institutional sign-in at Scopus site) 3 CitationsAbstract
BACKGROUND: Our internal infant sepsis evaluation clinical practice guideline recommends infants with negative culture results who are undergoing sepsis evaluation receive antibiotics until culture results are negative for a maximum of 36 hours. The aims of our project were to decrease the percentage of patients who received >30 hours of administered antibiotic doses (recognizing effective concentrations last until hour 36) and increase 36-hour phrase documentation by using clinical decision support tools.
METHODS: We used quality improvement methodology to study infants aged ≤60 days with negative culture results. The outcome measures were the percentage of patients who received >30 hours of administered antibiotic doses, the percentage of history and physical (H&P) notes that included a statement of the anticipated 36-hour antibiotic discontinuation time (36-hour phrase), and length of stay. The process measure was the use of an illness-specific H&P template or an influencer smartphrase. Balancing measures were readmissions for positive culture results. Interventions included education, an illness-specific H&P template, a criteria-based rule to default to this H&P template, and editing influencer smartphrases.
RESULTS: Over 33 months, 311 patients were included. Percentage of patients who received >30 hours of administered antibiotic doses decreased from 75.6% to 62%. Percentage of H&P notes documenting the 36-hour phrase increased from 4.9% to 75.6%. Illness-specific H&P template and influencer smartphrase usage increased to a mean of 51.5%; length of stay did not change. No readmissions for positive culture results were reported.
CONCLUSIONS: Clinical decision support techniques and educational interventions popularized the "36-hour phrase" and were associated with a reduction in the antibiotic exposure in infants with negative culture results hospitalized for sepsis evaluation.
Author List
Bauer SC, Kaeppler C, Soung P, Porada K, Bushee G, Havens PLAuthors
Sarah Bauer MD Associate Professor in the Pediatrics department at Medical College of WisconsinPeter Havens MD Emeritus Professor in the Pediatrics department at Medical College of Wisconsin
Paula Soung MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Anti-Bacterial AgentsDecision Support Systems, Clinical
Electronic Health Records
Humans
Infant
Quality Improvement
Sepsis
