Implementation and Evaluation of a Video-based Prospective Feedback Intervention to Improve Antimicrobial Stewardship in Neonatal Intensive Care Units

基于视频的前瞻性反馈干预措施的实施和评估，以改善新生儿重症监护病房的抗菌药物管理

• 批准号: 10431816
• 负责人: PETER JAMES MENDEL
• 金额: $ 42.2万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10431816
• 关键词: Implementation; Evaluation; Video; based; Prospective

Summary/Abstract The problem of antimicrobial misuse is well known and is a high priority action item for all of the major public health, infectious disease and US primary care societies. This reflects the existence of untreatable bacterial infections, a shallow manufacturer pipeline for new antibiotics, and continued misuse of antimicrobials by providers. In the neonatal intensive care unit (NICU) setting, antibiotics are the most frequently used medications, and very often inappropriately. Such use is associated with increased bacterial resistance, increased hospital length of stay, necrotizing enterocolitis, and even death. Drug usage decisions can be difficult in the NICU as infectious and non‐infectious conditions present similarly often leading to empiric overtreatment. Thus, it is not surprising there is substantial variation in antibiotic use among NICUs. Antimicrobial stewardship programs (ASP) mitigate against the consequences of poor antibiotic use resulting in improved patient outcomes, fewer adverse events, improved bacterial susceptibilities, and economic savings. Several ASP strategies are recommended, however common implementation problems include lack of provider buy‐in, consensus on best practice, attention to interactions among prescribers and other staff who manage patients, and tailoring of ASPs to clinical and institutional contexts. These challenges are exacerbated in settings in which high heterogeneity in patient indications and lack of expert consensus on treatment is present, such as the NICU. We propose to evaluate an innovative, scalable antimicrobial stewardship intervention called ECHO‐ ASP in NICUs participating in the largest statewide perinatal QI collaborative in the US. The intervention pairs prospective feedback (an ASP practice recommended by CDC) with the ECHO tele‐learning platform (Extension for Community Healthcare Outcomes). ECHO is an evidence‐based method of practice dissemination used globally in >120 health collaborations since 2003. Both parts of the ECHO‐ASP intervention—prospective feedback and the ECHO methodology—are grounded in an expert‐facilitated, case‐based learning model tailored to how clinicians are inclined to learn and build practice consensus. The Specific Aims of the project are to: 1) Evaluate the implementation of the ECHO‐ASP intervention including barriers and facilitators to implementation, site participation in video‐based prospective feedback and audit sessions, dissemination of session results to other local NICU prescribers, perceived acceptability and durability of the intervention, and practice consensus on antibiotic prescribing; 2) Evaluate the effectiveness of the ECHO ASP intervention on patient care outcomes, including antibiotic use, drug‐related adverse events, and other clinical complications; 3) Evaluate the cost implications of the ECHO ASP intervention, including implementation costs and effects on costs of care.

摘要/摘要 抗菌遗物的问题是众所周知的，并且是所有专业的高优先级动作项目 公共卫生，传染病和美国初级保健协会。这反映了不可治疗的存在 细菌感染，新抗生素的浅制造商管道，并继续滥用 提供者的抗菌剂。在新生儿重症监护病房（NICU）设置中，抗生素是最多的 经常使用的药物，而且经常不当。这种使用与增加有关 细菌抗性，住院时间增加，坏死性小肠结肠炎甚至死亡。药品 在NIC中，使用使用情况可能很困难，因为传染性和非感染条件类似 通常导致经验性过度治疗。那就不足为奇了，抗生素存在很大差异 在NICUS中使用。抗菌管理计划（ASP）减轻了穷人的后果 抗生素使用，导致患者的预后改善，广告活动较少，细菌改善 敏感性和经济节省。建议采用几种ASP策略，但是 实施问题包括缺乏提供商的买入，最佳实践的共识，注意 处方者和其他管理患者的员工之间的互动，并将ASP量身定制至临床和 制度环境。这些挑战在患者高异质性的环境中加剧了 存在迹象和缺乏治疗的专家共识，例如NICU。 我们建议评估一种创新的，可扩展的抗菌管理干预措施，称为Echo- NICUS中的ASP参加了美国最大的全州围产期Qi合作。干预 将预期反馈（CDC推荐的ASP实践）与回声电视平台配对 （社区医疗保健结果的扩展）。 Echo是一种基于证据的实践方法 自2003年以来，在> 120次健康合作中全球使用的传播。 干预措施 - 培养的反馈和回声方法 - 基于专家的智力， 基于病例的学习模型是针对临床医生倾向于学习和建立实践共识的量身定制的。 该项目的具体目的是：1）评估Echo-Asp干预的实施 包括障碍和促进者实施，网站参与基于视频的潜在 反馈和审核会议，将会话结果传播给其他本地NICU处方者，感知到 干预的可接受性和耐用性，并就抗生素处方实践共识； 2） 评估回声ASP干预对患者护理结果的有效性，包括抗生素 使用，与药物有关的不良事件和其他临床并发症； 3）评估成本的影响 回声ASP干预，包括实施成本以及对护理成本的影响。

项目成果

Changes in perceptions of antibiotic stewardship among neonatal intensive care unit providers over the course of a learning collaborative: a prospective, multisite, mixed-methods evaluation.

• DOI: 10.1038/s41372-023-01823-0
• 发表时间: 2024-01
• 期刊: JOURNAL OF PERINATOLOGY
• 影响因子: 2.9
• 作者: Qureshi, Nabeel;Kroger, Jack;Zangwill, Kenneth M.;Joshi, Neha S.;Payton, Kurlen;Mendel, Peter
• 通讯作者: Mendel, Peter

Blood culture procedures and practices in the neonatal intensive care unit: A survey of a large multicenter collaborative in California.

新生儿重症监护病房的血培养程序和实践：对加利福尼亚州大型多中心协作机构的调查。

• DOI: 10.1017/ice.2023.33
• 发表时间: 2023
• 期刊: Infection control and hospital epidemiology
• 影响因子: 4.5
• 作者: Lefrak,Linda;Schaffer,KristenE;Bohnert,Janine;Mendel,Peter;Payton,KurlenSE;Lee,HenryC;Bolaris,MichaelA;Zangwill,KennethM
• 通讯作者: Zangwill,KennethM