Elizabeth Monsees

Background/Objective: Penicillin allergy labels (PALs) contribute to broad-spectrum antibiotic use. Thorough documentation can help prescribers identify and remove unnecessary PALs. We aimed to improve documentation of PALs in three pediatric urgent care (PUC) clinics, using a nurse-initiated quality improvement (QI) approach. Methods: QI interventions included a survey to assess prescriber and nurse confidence, an online educational module, and an algorithm to aid in clarifying PALs. We measured the percentage of PALs with a clarified reaction severity as our primary outcome using annotated control charts. Descriptive and inferential statistics evaluated survey responses between nurses and prescribers. Results: Clarified PAL reaction severity had a sustained upward shift from 58.5% to 63.3% following implementation of our interventions. Of 129 nurses and prescribers, 87 (67.4%) respondents completed the survey. Prescribers and nurses reported feeling knowledgeable about PALs but experienced different challenges to clarifying PAL documentation. Prescribers reported time pressures as a barrier to PAL clarification more often than nurses (IQR [3, 4], p = 0.001). Nurses reported higher confidence in ability to document a PAL compared to prescribers (IQR [3.25, 5], p = 0.010). Respondents requested family education and practice guidance to aid PAL clarification. No consistent differences were noted in PAL documentation by sociodemographic characteristics. Conclusions: The nurse-initiated QI approach demonstrated improved PAL documentation in PUCs. Engaging nurses in antibiotic stewardship initiatives can provide new perspectives and broaden the approach to intervention design and implementation. Future efforts should focus on improving electronic health record and interprofessional workflow processes to build on these improvements.

We assessed healthcare workers’ knowledge, attitudes, and practices around disposable personal protective equipment (PPE) use. We observed that healthcare workers are interested in sustainable policies and identified areas for policy changes to reduce PPE waste.

Objective: The primary objective was to grade the potential impact of antimicrobial stewardship program (ASP) interventions on patient safety at a single center using a newly developed scoring tool, the Antimicrobial Stewardship Impact Scoring Tool (ASIST).Design: Retrospective descriptive study.Setting: A 367-bed free-standing, pediatric academic medical center.Methods: The ASP team developed the ASIST which scored each intervention on an impact level (low, moderate, high) based on patient harm avoidance and degree of antibiotic optimization. Intervention frequency and characteristics were collected between May 1, 2022 and October 31, 2023. Intervention rates per impact level were calculated monthly.Results: The ASP team made 1024 interventions further classified as low (45.1%), moderate (47%), and high impact (7.9%). The interventions for general pediatrics (53.9%) and those to modify formulation (62.2%), dose/frequency (58.1%), and duration (57.5%) were frequently low impact. Hematology/oncology (12.5%), sub-specialty (11.7%), and surgical services (11.3%) had the greatest rate of high-impact interventions. Interventions to broaden antibiotics (40.8%) and those associated with antibiotics used to treat bacteremia (20.6%) were frequently classified as high-impact.Conclusion: The ASIST is an effective tool to link ASP interventions to prevention of antimicrobial-associated patient harm. For our ASP team, it provided meaningful data to present to hospital leadership and identified opportunities to prevent future harm and reduce ASP team workload.

Objective: To evaluate the clinical impact and features associated with repeat tracheal aspirate (TA) cultures in children admitted to the intensive care unit.Design: Retrospective cohort study.Setting: A 338-bed freestanding, tertiary pediatric academic medical center with pediatric medical intensive care unit (PICU) and cardiac intensive care units (CICU).Patients: Children ≤18 years of age who were admitted to either the PICU or CICU who had ≥2 TA cultures in a single intensive care admission.Methods: Patients with ≥2 TA cultures between 2018 and 2019 were included in this study. The following information was collected: patient demographics, clinical data summarizing patient condition at the time of culture collection, number of TA cultures per patient, antibiotic usage, and microbiologic data. Descriptive statistics established the frequency of TA collection, time between culturing, clinical reasoning for collection, antibiotic exposure, and development of multidrug-resistant organisms (MDRO).Results: Sixty-three patients had repeat TA cultures and accounted for 252 TA cultures during the study period. Most patients with repeat TA cultures were admitted to the PICU (71%) and were male (65%). A median of 3 TA cultures per patient were obtained with 50% of repeat cultures occurring within 7 days from the previous culture. Sixty-six percent of patients had the same organism cultured on ≥2 TA cultures. Most antibiotics were not modified or continued to treat the results of the TA culture.Conclusions: Repeat TA cultures frequently show the same pathogens, and results do not often influence antibiotic selection or usage. Repeat TA cultures did demonstrate the development of MDROs.

This article explores the utility of implementation science (IS) as a method to promote the effective uptake of antimicrobial stewardship processes. Elements of IS can be readily incorporated into QI work and used as a platform to extend stewardship reach. As stewards are stretched to do more, IS can be a potential vehicle to ensure that our collective work is impactful, sustainable, and contributes more broadly to clinically relevant improvements.