#86: A Quality Improvement Study Using Blended Learning as Part of Antimicrobial Stewardship Program (ASP) to Improve Ampicillin Sulbactam Prescription in Pediatric Hospital in Bogotá, Colombia

Abstract

Background. Antimicrobial agents are the second most common prescribed drugs in hospital settings. Antibiotic resistance is a major public health problem. Some studies have found that 20-50% of antibiotics prescriptions are inadequate or not necessary. Ampicillin-sulbactam is the second most common prescribed antibiotic in inpatients children in our hospital. We designed a quality improvement study to improve ampicillin-sulbactam prescription in a third-level children hospital in Bogotá, Colombia. Methods. A before and after study was designed. We obtained days of treatment (DOT) for ampicillin-sulbactam in last 3 years (2017, 2018, and 2019). In October of 2019, we included ampicillin-sulbactam as a targeted antibiotic in our ASP. We focus the efforts in 2 principals' strategies: Educative strategy and audit and feedback strategy. Educative strategy included a blended learning intervention and audit and feedback strategy included surveillance of prescriptions in real time to evaluate local guidelines adherence with feedback to prescribers. We designed a form to collect and analyze data with Epi Info®. Results. In 2 months of surveillance, we reviewed and analyzed 67 prescriptions. Median age of patients was 2 years (0.75-7.5 years). The main diagnosis was pulmonary infection in 70.1% (multilobar pneumonia 13 patients, lobar pneumonia 8 patients and bacterial co-infected bronchiolitis in 5 patients). Three prescriptions were based in etiologic isolation while 64 was an empiric formulation. Only 24 prescriptions (35%) were considered adequate according to local guidelines. The principal's reasons of inadequate prescription were the possibility to use a narrow-spectrum antibiotic (58.1%) and error about inadequate infectious disease diagnosis (39.5%). In 43 of inadequate prescriptions, ASP changed the antibiotic in 24 patients, stopped all antimicrobial therapy in 14, and changed to oral rout in other 4. In the patient's follow-up, all have an adequate clinical course, and only 3 required to restart antimicrobial therapy. There were no deaths related to infectious diseases. In the educational strategy we trained 34 staff members (32.9%) with lectures and 72 staff members (69.2%) using virtual strategy. We use a pre- and post-test evaluations, with a score improvement in 33% after the educational strategy. Finally, we compared DOT of ampicillin-sulbactam for the last 3 years and we found a reduction of 65% in prescription between October 2017 and October 2019 (Figure 1). Conclusion. This is the first quality improvement study with an ASP targeting a narrow-spectrum antibiotic in children. Many ASP focused their efforts only in broad-spectrum antibiotics, but few studies have been published in narrow-spectrum antibiotics. The implementation of an ASP to improve prescription of ampicillin- sulbactam had a dramatic impact in reduction of prescriptions in our settings. The educational strategy using blended learning strategy is especially valuable in hospital education because virtual learning has a great flexibility and if facilitated by the high availability of mobile devices.