A pilot antibiotic stewardship program at a pediatric long-term care facility led to a 59% decrease in use of a topical antibiotic and an 83% decrease in orders for antibiotics without proper documentation during a six-month period, according to a study presented recently in Nashville at the annual APIC conference.

When the infection prevention team at Elizabeth Seton Pediatric Center in Yonkers, NY, noticed that certain antibiotics were being prescribed for a prolonged period of time and for non-infectious indications, they launched a trial program to make improvements in antibiotic prescribing and reduce the risk of antibiotic-resistant infections in their vulnerable patient population.

The results

With support from the medical director and the infectious disease physician of their 137-bed facility, the team conducted monthly audits of all antibiotics ordered from April to September 2014. They met regularly with physicians, pharmacists, nurses, and administrators to review the data and enlist staff support to reduce inappropriate antibiotic prescribing. The program aimed to cut the number of prescriptions without a documented indication, and to decrease the use of mupirocin, a topical antibiotic ointment, for non-infectious conditions such as skin rashes and abrasions. Both of these goals were achieved.

“Our children suffer from many chronic health conditions, and any way that we can reduce the potential for antibiotic resistance will be beneficial for them in the long run,” said Olivia Jackson, RN, infection control coordinator at Elizabeth Seton.

“While this is a pilot program, it is clear that we can make a sizeable impact by getting our healthcare providers to really think about why they are prescribing antibiotics and whether they are necessary.”

The researchers report that before transitioning to an electronic medical records system, healthcare providers in their facility often failed to document a reason for antibiotic prescriptions or failed to discontinue treatment when an appropriate duration had been completed document. A reason for antibiotic prescriptions or failed to discontinue treatment when an appropriate duration had been completed. With a new barrier built into the electronic medical records, providers are required to document the specific condition that dictates the need for the antibiotic they want to order.

Once this was in place, they noted a sharp decline in prescription numbers. Antimicrobial resistance is one of the most pressing issues facing healthcare, as the CDC says 2  million people are infected with resistant bugs annually and some 23,000 patients die.