RT Journal Article SR Electronic T1 Improving intravenous-to-oral antibiotic switch in children: a team-based audit and implementation approach JF BMJ Open Quality JO BMJ Open Qual FD British Medical Journal Publishing Group SP e001120 DO 10.1136/bmjoq-2020-001120 VO 10 IS 1 A1 Brendan Joseph McMullan A1 Michelle Mahony A1 Lolita Java A1 Mona Mostaghim A1 Michael Plaister A1 Camille Wu A1 Sophie White A1 Laila Al Yazidi A1 Erica Martin A1 Penelope Bryant A1 Karin A Thursky A1 Evette Buono YR 2021 UL http://bmjopenquality.bmj.com/content/10/1/e001120.abstract 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.