Pediatrics：质量改进可促进儿童肺炎抗菌药物合理使用

　　美国学者的一项研究表明，即使没有支持社区获得性肺炎（CAP）的慎重抗菌药处方的正式抗菌药物管理工作计划，质量改进（QI）方法也能迅速改善对国家指南的依从性。 相关论文发表于《儿科》杂志。  相关论文发表于

　　该研究纳入美国辛辛那提儿童医院医学中心的CAP患儿，使用QI方法来快速实现儿科传染病学会/美国传染病学会指南建议的合理一线抗菌药物治疗。QI干预集中在4个关键点，并在急诊和内科住院患者分别进行测试，使用多计划-执行-学习-行为周期。每周审查符合条件的患者的医疗记录，以确定处方建议抗菌药物治疗的成功性。随时间的推移跟踪这些干预措施对结局的影响。

　　结果显示，6个月内引入本地指南并持续3个月治疗后，急诊确诊的CAP患儿的合理一线抗菌药物处方从平均基线的0％增加到100％，住院患者从30％增加到100％。

Quality improvement methods increase appropriate antibiotic prescribing for childhood pneumonia
OBJECTIVE
In August 2011, the Pediatric Infectious Disease Society and Infectious Disease Society of America published an evidence-based guideline for the management of community-acquired pneumonia (CAP) in children ≥3 months. Our objective was to evaluate if quality improvement (QI) methods could improve appropriate antibiotic prescribing in a setting without a formal antimicrobial stewardship program.
METHODS
At a tertiary children’s hospital, QI methods were used to rapidly implement the Pediatric Infectious Disease Society/Infectious Disease Society of America guideline recommendations for appropriate first-line antibiotic therapy in children with CAP. QI interventions focused on 4 key drivers and were tested separately in the emergency department and on the hospital medicine resident teams, using multiple plan-do-study-act cycles. Medical records of eligible patients were reviewed weekly to determine the success of prescribing recommended antibiotic therapy. The impact of these interventions on our outcome was tracked over time on run charts.
RESULTS
Appropriate first-line antibiotic prescribing for children admitted with the diagnosis of CAP increased in the emergency department from a median baseline of 0% to 100% and on the hospital medicine resident teams from 30% to 100% within 6 months of introducing the guidelines locally at Cincinnati Children’s Hospital Medical Center and has been sustained for 3 months.
CONCLUSIONS
Our study demonstrates that QI methods can rapidly improve adherence to national guidelines even in settings without a formal antimicrobial stewardship program to encourage judicious antibiotic prescribing for CAP.