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Mentor, Preceptor, Principle Investigator

Rana El Feghaly, MD, MSCI

Description

Background: Skin and soft tissue infections (SSTIs) are the second most common diagnosis leading to pediatric antibiotic prescriptions in the outpatient setting after respiratory diagnoses. However, most antibiotic stewardship programs have mainly focused on respiratory diagnoses. Children seen in the ambulatory setting for SSTIs often receive >7 days of antibiotics, although current society guidelines recommend 5-7 days for most diagnoses. Objective: To increase the percentage of patients receiving 5-7 days of oral antibiotics for SSTIs from 58% to 75% by December 31st, 2021, in pediatric urgent care clinics (UCCs). Design/Methods: We formed a multidisciplinary team in April 2020. We completed cause-and-effect analyses and developed a driver diagram (Figure 1). Plan-Do-Study-Act (PDSA) cycle 1 provided an update on current guidelines for UCC providers. PDSA cycle 2 modified the electronic health record to display antimicrobial order sentences from shortest to longest duration. PDSA cycle 3 provided project outcome and balancing measure updates to UCC providers at regular intervals. We created a monthly report of patients 90 days and older seen in UCCs with a final diagnosis of SSTIs including impetigo, abscesses, cellulitis, erysipelas, folliculitis, paronychia, and animal bites. Our outcome measure is the percentage of patients receiving 5-7 days of oral antibiotics for SSTIs. Process measure is the percentage of prescriptions selected from a folder. Balancing measure is the number of patients returning for SSTI within 14 days of their visit. Results are displayed using an annotated control chart. Results: The percentage of patients receiving 5-7 days of oral antibiotics during the baseline period (June 2019-June 2020) was 58%. After project initiation in April 2020, this increased to 68%, and consistently increased following PDSA cycles to a sustainable rate of >80% (Figure 2). A total of 1,971 UCC visits were included in the analysis. Process measure revealed less than 10% of providers utilize prescription folders. There was no change in balancing measure numbers. Conclusion: Prior to our project, only 58% of children seen in pediatric UCCs for SSTIs received the recommended antibiotic duration. By addressing primary drivers uncovered through QI methodology, we surpassed our goal of 75%. Additional PDSA cycles are planned along with expansion to other departments. This work will allow us to expand antibiotic stewardship efforts to other infectious diagnoses as well.

Presented at 2022 PAS Conference; Denver, CO; April 2022.

Publication Date

4-2022

When and Where Presented

Presented at 2022 PAS Conference; Denver, CO; April 2022.

Improving Antibiotic Durations for Skin and Soft Tissue Infections in Pediatric Urgent Care Clinics

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