Improving Antimicrobial Prescribing Practices in the Neonatal Intensive Care Unit

改善新生儿重症监护病房的抗菌药物处方实践

• 批准号: 7483849
• 负责人: LISA SAIMAN
• 金额: $ 80.18万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-07-24 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7483849
• 关键词: Acute; Address; Adult; Aftercare; Antibiotic Resistance; Antibiotic Therapy; Antibiotics; Antimicrobial Resistance; Beds; Belief; Caring; Categories; Centers for Disease Control and Prevention (U.S.); Childhood; Clinical; Clinical Trials; Computers; Data; Education; Educational Intervention; Effectiveness of Interventions; Electronic Health Record; Feedback; Goals; Government; Hand; Health; Health behavior change; Hospitalized Child; Hospitals; Infant; Infection; Intensive Care Units; Intervention; Knowledge; Length of Stay; Link; Measures; Medical; Modeling; Monitor; Morbidity - disease rate; Multi-Drug Resistance; Neonatal; Neonatal Intensive Care Units; Organism; Outcome; Patients; Pattern; Population; Population Intervention; Provider; Randomized; Rate; Reinforcing Factor; Research Design; Resistance; Resources; Risk; Sepsis; Testing; United States; antimicrobial; base; computerized; cost; cost effective; cost effectiveness; density; desire; improved; innovation; mortality; pathogen; prevent; programs; prospective; success

The increased emergence of antibiotic resistance has been linked to the overuse of antibiotics, particularly in hospitals. Antimicrobial stewardship programs are widely acknowledged as essential to improve appropriate antibiotic use, decrease antimicrobial resistance, and reduce cost. However, few data exist describing the efficacy of such programs in pediatric populations, particularly in the neonatal intensive care unit (NICU). The long-term objectives of this study are to reduce antimicrobial resistance by implementing innovative interdisciplinary interventions aimed to improve antibiotic prescribing practices in the NICU and thereby define the optimal interventions for this population. The Specific Aims are to: 1) measure the impact of three interdisciplinary intervention bundles on inappropriate antimicrobial use as categorized by the CDC 12 Step Campaign Program to Prevent Antimicrobial Resistance; 2) determine the impact of these . intervention bundles on resistance density, i.e., changes in the rate of infant infections and colonization with multidrug-resistant organisms (MDROs) and changes in the proportion of MDROs carried on NICU staff hands; and 3) determine the cost effectiveness of the intervention bundles in preventing bloodstream infections caused by MDROs. The Study Design is a quasi-experimental prospective clinical trial whereby 4 study NICUs in the United States (total beds - 214, annual discharges - 3649) will berandomized to successive bundles of interventions versus usual care to determine which combinations of interventions have the greatestjmpact on appropriate antibiotic use, antimicrobial resistance, and cost. The interventions have beendeveloped using the PRECEDE-PROCEEDhealth promotion planning model which suggests that programsto change health behavior should include predisposing, enabling, and reinforcing factors. Thus, the Education intervention in this study addresses the predisposing knowledge and beliefs of staff regarding antimicrobial resistance and helps set goals for improving prescribing practices. The Clinical Decision Support- Computerized Provider Order Entry intervention provides computer prompts in the electronic health record to enable better decisions about stopping, changing, or continuing antibiotic treatment. The Audit and Prescriber Feedback intervention reinforces desired prescribing practices as providers can monitor the success of their prescribing decisions on health outcomes and receive praise and encouragement from the study team.

抗生素耐药性的出现增加与抗生素过度使用有关，特别是 在医院。抗菌管理计划被广泛认为对于改进至关重要 适当的抗生素使用，降低抗菌素耐药性并降低成本。但是，很少有数据 描述此类计划在儿科人群中的功效，尤其是在新生儿重症监护室中 单位（NICU）。这项研究的长期目标是通过实施来降低抗菌素耐药性 创新的跨学科干预措施旨在改善NICU和 从而定义了该人群的最佳干预措施。具体目的是：1）衡量影响 CDC分类的三个跨学科干预捆绑包 12步骤运动计划，以防止抗菌素抗性； 2）确定这些影响。 干预束在电阻密度上，即婴儿感染率的变化和定植与 多药耐药生物（MDROS）和NICU员工的MDRO的比例变化 手3）确定干预束的成本效益在防止血液中 由MDRO引起的感染。 研究设计是一项准实验的前瞻性临床试验 州（总床-214，年度出院-3649）将被寄给连续的捆绑包 干预措施与通常的护理，以确定哪些干预措施的组合具有最大的作用 适当使用抗生素，抗菌素耐药性和成本。干预措施已经发展 使用PrecDe-ProceedHealth促销计划模型，该模型表明ProgramSto更改 健康行为应包括诱发，启用和加强因素。因此，教育 这项研究的干预涉及员工对抗菌剂的诱人知识和信念 阻力并有助于设定改善处方实践的目标。临床决策支持 - 计算机提供者订单入门干预提供了电子健康记录中的计算机提示 可以更好地决定停止，更改或继续进行抗生素治疗。审核和 处方干预措施加强了所需的处方实践，因为提供者可以监视 他们对健康成果的规定决定的成功，并受到赞美和鼓励 学习团队。