Background: Pneumonia is the biggest killer of children under 5 years of age especially in developing countries. The management usually is not evidence based or does not follow the guidelines with consequent hazards. We collaborated with American Academy of Pediatrics’ (AAP) initiative Value in Inpatient Pediatrics Network(VIP) Improving Community Acquired Pneumonia (ICAP) Quality improvement project to change the paradigm at our hospital. We were the only developing country site to collaborate this initiative. Objectives: To increase the evidence-based management of children hospitalized with community acquired pneumonia (CAP) by following the management guidelines published jointly by the Pediatric Infectious Diseases Society (PIDS) and Infectious Diseases Society of America (IDSA) in 2011. Among 10 parameters addressed were to increase the use of narrow spectrum antibiotics (Ampicillin/amoxicillin) to 80% in emergency/inpatients, to decrease the use of macrolides to 5% in under 5 age group and decreasing concurrent treatment of pneumonia/asthma to less than 10%. Methodology: The expert panel of the VIP’s Quality Improvement Innovation Networks (QuIIN) developed project measures, goals, and interventions. A change package of evidence-based tools to promote judicious use of antibiotics and raise awareness of asthma and pneumonia co diagnosis was developed. We implemented series of interventions for peer coaching including information dissemination, interactive discussions and webinars with care providers at all levels. Data was collected through chart review across emergency department (ED), inpatient, and discharge settings at baseline and then over 5 improvement cycles. We reviewed up to 10-20 charts in each of 3-month cycle. Analysis of means with 3-σ control limits was the primary method of assessment for change. The Baseline percentages were compared with final cycle using Fisher’s exact test. Results: Over the 1-year project (July 2014-June 2015), a total of 120 charts were reviewed; 59 during baseline cycles and 61 during post intervention cycles. The use of narrow spectrum antibiotics increased from less than 20% to over 80% in ED, inpatient and at discharge. Similarly use of macrolides decreased from over 80% to less than 5% in all settings i.e. ED, inpatient and at discharge. The use of concurrent asthma treatment reduced from 60% to zero percent in the inpatient settings. The use of chest X-ray came down to 50% from 100% for admitted patients. The use of chest ultrasound increased from zero to 100%. The minimum improvement was seen in the use of complete blood count(CBC) that decreased from 100% to 83% only. There was no change in the use of CT scan, repeat chest X-ray and repeat CBC in pre and post intervention period. Conclusion: This real time experience of practically implementing low-cost strategies including narrow spectrum antibiotics use in a developing country with consequent benefits can be an impetus for other low resourced centers.
Improving care in children presenting with Community Acquired Pneumonia at a tertiary care hospital of a developing country through multi-disciplinary approach.
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Ghulam Mustafa; Improving care in children presenting with Community Acquired Pneumonia at a tertiary care hospital of a developing country through multi-disciplinary approach.. Pediatrics August 2019; 144 (2_MeetingAbstract): 578. 10.1542/peds.144.2MA6.578
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