Implementation of quality improvement intervention reduces medication use in premature babies: Study

A new study by Pediatrix Medical Group researchers has found that the implementation of a quality improvement intervention significantly reduces the use of a large number of medications in premature babies across a broad neonatal intensive care network. The findings, presented in a platform session at the Pediatric Academic Societies (PAS) Annual Meeting in Vancouver, Canada, demonstrate the important role of quality improvement initiatives in providing neonatal patients with the best possible care, which includes potential benefits such as: improved outcomes, decreased risk of side effects and possible medication errors, as well as reduced medication costs.

The quality improvement intervention process consisted of an ongoing educational program and automated feedback reports of medication usage for each of the 239 neonatal intensive care units (NICUs) and was designed to generate awareness amongst clinicians about current data, risks and benefits associated with medications frequently used in neonatal care. The goal of the study was to determine the effectiveness of a multi-faceted quality improvement intervention in reducing the use of many medications that have been poorly studied in this population, that have not demonstrated clinical benefits, or that carry significant adverse effects to neonatal patients. The targeted medications were: the antibiotic cefotaxime, gastrointestinal medications metoclopramide and H-2 blockers, the diuretic spironolactone, and the hormone erythropoietin.

The physician research team, Dan L. Ellsbury, M.D., Reese H. Clark, M.D., Robert Ursprung, M.D., and Alan R. Spitzer, M.D., all of the Pediatrix Center for Research, Education and Quality, believes that the success of this quality intervention initiative in a large and diverse national group of NICUs provides support for further large scale quality improvement efforts in neonatal intensive care, and suggest that this type of intervention initiative can serve as a model for quality improvement in other specialty areas of patient care.

The study was conducted with data from Pediatrix's Clinical Data Warehouse, one of the largest-known neonatal databases. Pediatrix researchers analyzed data for 49,777 infants born between 2003 and 2008 with a birth weight of 501-1,500 grams, about 1 to 3 pounds, comparing baseline medication usage in 2003 to post-intervention usage in 2008. Following the quality improvement intervention initiative from 2005-2007, a significant reduction was seen in the use of all targeted medications.

Through daily progress notes prepared by neonatologists, Pediatrix's physicians have contributed clinical information that has been aggregated into the organization's Clinical Data Warehouse, which now offers outcome reporting for more than 600,000 neonatal patients and more than 12 million neonatal patient days. Using information from this large-scale database, physicians have conducted research for various studies also being presented at the 2010 PAS meeting, including:

• Indomethacin Compared to Ibuprofen: Does It Matter Which One We Use? [Abstract: 2845.223]

• Epidemiology of Group B Streptococcus (GBS) and Escherichia coli (E. coli) Infections in Infants in the Era of Intrapartum Antibiotic Prophylaxis (IAP) [Abstract: 2630.2]

• Coagulase Negative Staphylococcus (CoNS) Sepsis in the Neonatal Intensive Care Unit [Abstract: 4412.418]

• Urinary Tract Infection (UTI) Concordance with Blood and Cerebrospinal Fluid (CSF) Cultures in the Neonatal Intensive Care Unit [Abstract: 4412.408]