Implementation of a Pilot Antimicrobial Stewardship Program in Pediatric Long Term Care

Abstract

Antimicrobial stewardship programs have been shown to decrease the length of hospitalization and risk of readmission in pediatric acute care facilities and decrease morbidity and mortality in adult facilities. Due to the high use of antibiotics in pediatric long term care facilities, we sought to determine the effectiveness of a pilot antimicrobial stewardship program in this setting. A multidisciplinary team implemented a pilot antimicrobial stewardship program in April 2014 at a 137-bed pediatric long term care facility. Two target goals for the program were initially instituted: decrease in the number of orders for antibiotics without a documented indication; decrease in the use of mupirocin for skin rashes and/or abrasions by establishing appropriate indications. The program was implemented by conducting monthly audits of antibiotic use and providing prescriber feedback. The effectiveness of the program was determined by comparing these outcomes from April-June (Q2) 2014 to July-September (Q3) 2014. From Q2 2014 to Q3 2014 there was a 59% decrease in mupirocin use and 83% decrease in orders without an indication. In September 2014, all the mupirocin orders were for appropriate indications. The pilot antimicrobial stewardship program was effective in decreasing inappropriate use of mupirocin and increasing the number of orders with a documented indication. The implementation of an electronic medical record in September 2014 likely facilitated documentation as it forced clinicians to indicate their diagnosis. Additional parameters for antimicrobial stewardship should be implemented and studied determine the long term effects of the program.