December 23, 2016

Teams have been collecting baseline data on all infants administered antibiotics for the past few months and getting ready to attend the January 10th kickoff meeting.  Current enrollment in North Carolina stands at 37 teams with more teams joining.   PQCNC can estimate out of the 120,000 births that occur annually in North Carolina, we will impact approximately 50% of those births throughout this initiative. With a conservative range of 6-10% of those infants receiving prophylactic treatment for sepsis, the current rate of exposure to antibiotics in the state is 3600-6000 infants annually.

With an aim of reducing exposure and duration of antibiotics by 20%, PQCNC and quality improvement teams across the state will protect 720 – 1200 infants from unnecessary exposure to antimicrobials with improvement efforts. 

As Dr. Srinivasan, the Associate Director for Healthcare-Associated Infection Prevention program at the CDC points out, “We can't control how fast bacteria develop resistance or how fast we develop new drugs, but antibiotic stewardship is 100% under our control.” 

November 16, 2016

The American Board of Pediatrics (ABP) has approved the Perinatal Quality Collaborative of North Carolina (PQCNC) application for Antibiotic Stewardship and Newborn Sepsis (ASNS) Project. This project is approved for the period 11/01/2016 - 09/30/2018. Physicians who participate in this project and meet ABP completion requirements will receive credit for the Performance in Practice component of Maintenance of Certification (MOC).

PQCNC ASNS ABP MOC Approval Letter by kcochran on Scribd

November 4, 2016

Baseline data collection has officially begun for our teams working on Antibiotic Stewardship/Newborn Sepsis and we (and they) are preparing for our January 2017 kickoff meeting.  In addition to working closely with teams across the state that have committed to this quality improvement initiative, we are supporting teams in Illinois, Hawaii and Virginia and fielding enquiries from other states considering joining. We will also be supporting a team in Italy at Ospedale Versilia in Camaiore (in the region of Tuscany) as they too strive to safely decrease antibiotic exposure in the fragile newborn population. 

Collaborating across the state, across the country, and around the world is not only an opportunity to impact the care of even more newborns, it is an opportunity to share best practice, foster relationships, and empower one another to continually strive toward optimal outcomes.

September 30, 2016

Team registration for Antibiotic stewardship/Neonatal sepsis (ASNS) is well underway.  Teams have submitted letters of intent and are finalizing team rosters.  

As registration continues, Dr. Carl Seashore, a general pediatrician at University of North Carolina (UNC), has been conducting site visits to potential hospital teams to discuss the use and implementation of the Kaiser sepsis calculator.  While not a requirement for participation in the ASNS initiative, use of the calculator is a recommendation for teams to support the decrease in exposure to any antimicrobial for infants born at greater than 34 weeks gestation with a maternal indication and/or clinical presentation of sepsis.  Dr. Seashore has been utilizing the Kaiser sepsis calculator in the Newborn Nursery at UNC with a limited population of infants and has been able to demonstrate a significant reduction in the number of infants exposed to antimicrobials.

Baseline data collection for the ASNS initiative will begin in November 2016 and continue for three months.  A kickoff meeting will be held in January 2017 with initiative data collection to begin in February 2017.

August 24, 2016

Antibiotic Stewardship/Neonatal Sepsis expert team met and finalized details of the action plan and baseline and initiative data collection forms.  Three breakout sessions were held to focus on specific aspects of the action plan:  Identification and Initiation was facilitated by Dr. Carl Seashore from UNC; Treatment was facilitated by Dr. Marie Thigpen from Rex Hospital; and Evaluation was facilitated by Dr. William Dalzell from Vidant Medical Center.  Discussions from each breakout session were presented and consensus was reached in order to finalize the action plan. 

Registration is now open
for teams to enroll in the initiative and individual team recruitment is underway.

Baseline data collection will begin soon and is scheduled to continue for three months to provide participating teams with a complete picture of current practices in antibiotic prescribing.  Teams will also complete a unit snapshot to provide more detailed data on unit operations to assist with performance improvement efforts.

July 20, 2016

Data collection points for ASNS have been finalized by the Expert Team.  Data collection will focus on the prescribing indication for antibiotics and the duration of treatment of specific antibiotics with a positive and a negative blood culture result during the first 48 hours of life.

Antibiotic use measures will be defined as days of therapy as supported by the CDC and will be collected as a measure in baseline data collection and throughout the data collection period.

The Expert Team is now beginning the work of converting data collection into action planning steps in a driver diagram using the IHI/CDC Driver Diagram change package as a model.

June 15, 2016

The goal of ASNS is to safely decrease the number of patients exposed to any antibiotic as well as decrease the number of patients treated for sepsis beyond the first 48 hours of life in the absence of a positive blood culture.

While the Center for Disease Control (CDC) fully endorses and supports Antibiotic Stewardship Programs to improve antibiotic use in hospitals, they also recognize that due to the complexity of medical decision making, there is no single template one can use to optimize antibiotic prescribing in hospitals.  

To help bridge this gap, expert team members are working to determine the most relevant data points necessary to capture meaningful information that will help guide clinical practice change. 

May 9, 2016

Thank you for the great discussion from the Expert Team on the May 3 conference call! I've incorporated all comments and clarified our AIM statement. 

Click here to access the final Charter

The next step is to begin thinking about what reports and data we would like to collect for the project.  If you have ideas on what reports you would like to be able to run from Delphi, the reporting system for PQCNC, please email me and let me know.  Data reporting will include many ideas and suggestions from the Expert Team so the more information I can obtain prior to the next call, the more focused our discussion will be.  Our next call is scheduled for May 24 at noon.  We will send out reminders and the call in information prior to that date.

April 21, 2016

Thank you to all who submitted their insightful thoughts, ideas and suggestions for the charter for PQCNC Antibiotic Stewardship! The collated responses were utilized to compose the draft charter.  Please read through the charter and reflect on what has been suggested to frame our work going forward. 

Our next conference call is scheduled for May 3 at noon.  We will discuss the information contained in the charter and will finalize the document by the end of the conference call.  I am expecting great discussion so please mark your calendars!

Call in information will be sent out closer to the date of the call. 

Click here to access draft Charter