Measurement Strategy

The project team used the Model for Improvement to guide testing of the resources. Process, outcome and balancing measures were selected and measured each week using a sample of five eligible patient records to see if changes resulted in improvement.

Primary process measures were:

• Time taken to switch eligible patients from intravenous (IV) antibiotics to oral antibiotics
• Percentage of eligible patients that were switched to oral antibiotics within 24 hours

Outcome measures were:

• Duration of IV antibiotic therapy in eligible patients
• Length of inpatient hospital stay in eligible patients

Balancing measures were:

• Readmission within 7 days due to infection
• Recommencement of IV antibiotics within 48 hours of oral switch

Results of the project were presented at:

• Clinical Excellence Commission
  CEC Antimicrobial Stewardship Forum, September 2017
• The University Of Queensland
  Centre of Research Excellence in Redefining Antimicrobial Use to Reduce Resistance
  The National Antimicrobial Resistance Forum, November 2017
• The 43rd Society of Hospital Pharmacists of Australia
  National Conference 'Medicines Management 2017', November 2017
• The Australasian Society for Infectious Diseases
  ASID Annual Scientific Meeting 2018

The team found a quality improvement approach was an effective way to support timely, safe and appropriate IV-to-oral antibiotic switch in children. A moderate improvement in the percentage of patients who were switched within 24 hours of eligibility was achieved, and reduction in median duration of intravenous antibiotic therapy, without any safety signals of concern. Continued education and further evaluation is important to sustain this effect and drive further improvement. The team are planning to publish results in a peer-reviewed journal in the near future.