Quality improvement program tries to reduce vancomycin use

July 6, 2020

Reducing antibiotic resistance has been a high priority for quality improvement programs. How well did one program do in reducing vancomycin use?

The drive to reduce antibiotic resistance has led to reduce the use of commonly prescribed antibiotics such as vancomycin. A report in Pediatrics examines whether a quality improvement initiative could change how 1 neonatal intensive care unit (NICU) prescribed vancomycin.1

Investigators created a quality improvement framework that included physician education that involved benchmarking for antibiotic prescribing rates; pharmacy-initiated 48-hour antibiotic time-outs on rounds; developing clinical pathways to standardize empirical antibiotic choices for certain situations such as necrotizing enterocolitis; and a daily audit that included feedback from an antimicrobial stewardship program. The program was deployed in a 60-bed level IV NICU in an academic referral center.

Statistical process u-charts were used to indicate that the use of vancomycin had declined from 112 to 38 days of therapy per 1000 patient-days. Following education, development of clinical pathways, and pharmacy-initiated 48-hour time-outs, the use of vancomycin declined by 29%. It declined by an additional 52% when it implemented the daily audit. They also found that acute kidney injury associated with vancomycin declined from 1.4 to 0.1 events per 1000 patient-days.

The researchers concluded that the implemented quality improvement program led to a decline in the use of vancomycin over a year and the decline was maintained over another year.


1. Hamdy R, Bhattarai S, Basu S et al. Reducing vancomycin use in a level IV NICU. Pediatrics. 2020:145(6):e20192963. doi:10.1542/peds.2019-2963