Antibiotic Stewardship in Newborn Care
Choosing Antibiotics Wisely: Combating Misuse and Overuse
Improve Antibiotic Use in Newborns
Reducing antibiotic use has many benefits beyond combating antibiotic resistance. By using a sepsis risk calculator and employing current evidence-based practices for antibiotic use, VON teams are reducing length of separation of mothers and infants, which improves breastfeeding rates, and reducing unnecessary length of stay.
Hospitals often have antibiotic stewardship teams focused on adult patients but caring for infants, especially in the NICU, brings unique challenges that we address with standardized protocols and evidence-based successful practices.
In collaboration with the CDC in 2015, VON teams made a commitment to reduce antibiotic use rates by 25%. Three years later, 187 centers from 38 states and 7 countries surpassed that goal and achieved a 34% reduction in AUR. We are now committed to reducing the rate to 45% by 2022.
Centers can help achieve this goal with participation in QI Implementation Packages, Universal Training in Choosing Antibiotics Wisely, or the VON/IHI online course, Practical Foundations in Improvement Science, to develop skills in quality improvement in the context of antibiotic stewardship.
QI Implementation Package
The implementation package for statewide perinatal quality improvement groups and health systems is designed for the systematic rapid-cycle adoption of the latest evidence-based practices to combat antibiotic over-use and misuse in the NICU, newborn nurseries, and network referral hospitals.
Additionally, VON Day Audits show data reported at the center and group level to provide a useful gap analysis and benchmarks to inform improvement efforts and track progress throughout the improvement cycle.
Reducing overuse of antibiotics in newborns without increasing infection rates requires developing standardized clinical processes for the entire interdisciplinary care team and consistent measurement to adjust practices and show results.
Through Universal Training for Choosing Antibiotics Wisely, online lessons presented by world-class experts and other resources supporting adoption of potentially better practices help teams improve the quality, safety, and value of care while reducing antibiotic exposure, reducing stress on families, improving family engagement and satisfaction, and reducing risk of infection.
CME/CNE/CPE is available for educational activities.
Wide Variation of Antibiotic Use in Newborn Care
Our paper published in Pediatrics (December 2018), Adherence of Newborn-Specific Antibiotic Stewardship Programs to CDC Recommendations, shows the opportunity newborn care units have to improve antibiotic use.
We found significant gaps exist between CDC recommendations to improve antibiotic use and actual antibiotic practices during the newborn period.
The data also showed wide variation in antibiotic use among centers providing newborn care.
Importantly, we recognize the opportunity for improvement as three-quarters of infants who received antibiotics for more than 48 hours did not have infections proven by using cultures.
Quality Improvement at VON
Dedicated to continuous improvement
More than 700 teams in VON quality improvement collaboratives and have accelerated improvement for the entire neonatal community of practice.
Teams learn how to use data to inform improvement plans that lead to measurable results, which are presented at the VON Annual Quality Congress and elsewhere.
The QI methodologies that teams become proficient in through hands-on work in VON collaboratives inform improvement in other areas of their work with infants and families in the NICU and other care settings.
The most successful teams integrate parents into the improvement teams and partner with families to advance family-integrated care.
Ultimately, participation in VON quality improvement gives teams the tools, guidance, and momentum they need to sustain continuous improvement.