PT  - JOURNAL ARTICLE
AU  - Brendan Joseph McMullan
AU  - Michelle Mahony
AU  - Lolita Java
AU  - Mona Mostaghim
AU  - Michael Plaister
AU  - Camille Wu
AU  - Sophie White
AU  - Laila Al Yazidi
AU  - Erica Martin
AU  - Penelope Bryant
AU  - Karin A Thursky
AU  - Evette Buono
TI  - Improving intravenous-to-oral antibiotic switch in children: a team-based audit and implementation approach
AID  - 10.1136/bmjoq-2020-001120
DP  - 2021 Mar 01
TA  - BMJ Open Quality
PG  - e001120
VI  - 10
IP  - 1
4099  - http://bmjopenquality.bmj.com/content/10/1/e001120.short
4100  - http://bmjopenquality.bmj.com/content/10/1/e001120.full
SO  - BMJ Open Qual2021 Mar 01; 10
AB  - Children in hospital are frequently prescribed intravenous antibiotics for longer than needed. Programmes to optimise timely intravenous-to-oral antibiotic switch may limit excessive in-hospital antibiotic use, minimise complications of intravenous therapy and allow children to go home faster. Here, we describe a quality improvement approach to implement a guideline, with team-based education, audit and feedback, for timely, safe switch from intravenous-to-oral antibiotics in hospitalised children. Eligibility for switch was based on evidence-based guidelines and supported by education and feedback. The project was conducted over 12 months in a tertiary paediatric hospital. Primary outcomes assessed were the proportion of eligible children admitted under paediatric and surgical teams switched within 24 hours, and switch timing prior to and after guideline launch. Secondary outcomes were hospital length of stay, recommencement of intravenous therapy or readmission. The percentage of children switched within 24 hours of eligibility significantly increased from 32/50 (64%) at baseline to 203/249 (82%) post-implementation (p=0.006). The median time to switch fell from 15 hours 42 min to 4 hours 20 min (p=0.0006). In addition, there was a 14-hour median reduction in hospital length of stay (p=0.008). Readmission to hospital and recommencement of intravenous therapy did not significantly change postimplementation. This education, audit and feedback approach improved timely intravenous-to-oral switch in children and also allowed for more timely discharge from hospital. The study demonstrates proof of concept for this implementation with a methodology that can be readily adapted to other paediatric inpatient settings.