Obstetrics and Gynecology, Sitaram Bhartia Institute of Science and Research, New Delhi, Delhi, India.
Quality, Sitaram Bhartia Institute of Science and Research, New Delhi, Delhi, India.
BMJ Open Qual. 2021 Jul;10(Suppl 1). doi: 10.1136/bmjoq-2021-001413.
In 2017, a postoperative multidrug resistant case of urinary tract infection made obstetricians at Sitaram Bhartia Institute of Science and Research introspect the antibiotic usage in labouring mothers. Random case file reviews indicated overuse and variability of practice among care providers. This prompted us to explore ways to rationalise antibiotic use.
A multidisciplinary team of obstetricians, paediatricians and quality officers was formed to run this improvement initiative at a private hospital facility in India. Review of literature advocated formulating a departmental antibiotic policy. Creating this policy and implementing it using improvement methodology helped us rationalise antibiotic usage.
We aimed to reduce the use of antibiotics from 42% to less than 10% in uncomplicated vaginal deliveries. We tested a series of sequential interventions using the improvement methodology of Plan-Do-Study-Act (PDSA) cycles, an approach recommended by the Institute for Healthcare Improvement. Learning from the PDSA cycle of the previous intervention helped decide the subsequent change ideas. The interventions included creation of a departmental antibiotic policy, staff engagement, and modification in documentation, concept of dual responsibility and team huddles as feedback opportunities. Information was analysed to understand the progress and improvement with change ideas.
Background analysis revealed that antibiotic usage ranged from 24% to 69% and average rate of antibiotic prophylaxis was high (42.28%) in low-risk uncomplicated vaginal deliveries. The sequential changes resulted in reduction in antibiotic usage to 10% in the target population by 4 months. Sustained improvement was noted in the following months.
We succeeded in implementing a departmental antibiotic policy aligning it with existing international guidelines and our local challenges. Antibiotic stewardship was one of the first major steps in our journey to avoid multidrug-resistant infections. Sustaining outcomes will involve continuous feedback to ensure engagement of all stakeholders in a hospital setting.
2017 年，斯瑞曼·巴蒂亚研究所的妇产科医生对一例术后多重耐药的尿路感染病例进行了反思，认为在产妇分娩过程中抗生素的使用存在问题。随机病历审查显示，医护人员的实践存在过度使用和差异。这促使我们探索合理使用抗生素的方法。
在印度的一家私立医院设施中，一个由妇产科医生、儿科医生和质量官员组成的多学科团队成立，负责开展这项改进计划。文献回顾主张制定部门抗生素政策。制定和实施该政策，采用改进方法，帮助我们合理使用抗生素。
我们的目标是将复杂的阴道分娩中抗生素的使用从 42%减少到 10%以下。我们使用改进方法的计划-执行-研究-行动（PDSA）循环测试了一系列连续干预措施，该方法是由医疗保健改进研究所推荐的。从之前干预的 PDSA 循环中学习有助于决定后续的变更思路。这些干预措施包括制定部门抗生素政策、员工参与、修改文件、双重责任和团队会议的概念，作为反馈机会。通过分析信息了解进展和改进情况。
背景分析显示，抗生素的使用范围从 24%到 69%不等，低风险的简单阴道分娩中抗生素预防的平均使用率很高（42.28%）。通过连续的变化，在 4 个月内将目标人群中的抗生素使用率降低到 10%。在接下来的几个月中，我们注意到持续的改进。
我们成功地实施了一项部门抗生素政策，使其与现有的国际指南和我们当地的挑战保持一致。抗生素管理是我们避免多重耐药感染的旅程中的第一步。维持成果将涉及持续反馈，以确保医院环境中所有利益相关者的参与。
