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Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics
Quality Reports

A Quality Improvement Initiative To Improve Postdischarge Antimicrobial Adherence

Sheena Gupta, Britanny Winckler, Michelle A. Lopez, Marco Costilla, Jennifer McCarthy, Jeffrey Wagner, Amanda Broderick, Katherine French, Brittany Le and Huay-ying Lo
Pediatrics January 2021, 147 (1) e20192413; DOI: https://doi.org/10.1542/peds.2019-2413
Sheena Gupta
aDepartment of Pediatrics, Baylor College of Medicine, Houston, Texas; and
bTexas Children’s Hospital, Houston, Texas
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Britanny Winckler
aDepartment of Pediatrics, Baylor College of Medicine, Houston, Texas; and
bTexas Children’s Hospital, Houston, Texas
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Michelle A. Lopez
aDepartment of Pediatrics, Baylor College of Medicine, Houston, Texas; and
bTexas Children’s Hospital, Houston, Texas
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Marco Costilla
bTexas Children’s Hospital, Houston, Texas
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Jennifer McCarthy
bTexas Children’s Hospital, Houston, Texas
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Jeffrey Wagner
bTexas Children’s Hospital, Houston, Texas
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Amanda Broderick
aDepartment of Pediatrics, Baylor College of Medicine, Houston, Texas; and
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Katherine French
aDepartment of Pediatrics, Baylor College of Medicine, Houston, Texas; and
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Brittany Le
aDepartment of Pediatrics, Baylor College of Medicine, Houston, Texas; and
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Huay-ying Lo
aDepartment of Pediatrics, Baylor College of Medicine, Houston, Texas; and
bTexas Children’s Hospital, Houston, Texas
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Abstract

OBJECTIVES: Bedside delivery of discharge medications improves caregiver understanding and experience. Less is known about its impact on medication adherence. We aimed to improve antimicrobial adherence by increasing on-time first home doses for patients discharged from the pediatric hospital medicine service from 33% to 80% over 1 year via creation of a discharge medication delivery and counseling “Meds to Beds” (M2B) program.

METHODS: Using sequential plan-do-study-act cycles, an interprofessional workgroup implemented M2B on select pediatric hospital medicine units at our quaternary children’s hospital from October 2017 through December 2018. Scripted telephone surveys were conducted with caregivers of patients prescribed antimicrobial agents at discharge. The primary outcome measure was on-time administration of the first home antimicrobial dose, defined as a dose given within the time of the inpatient dose equivalent plus 25%. Process measures primarily assessed caregiver report of barriers to adherence. Run charts, statistical process control charts, and inferential statistics were used for data analysis.

RESULTS: Caregiver survey response rate was 35% (207 of 585). Median on-time first home antimicrobial doses increased from 33% to 67% (P < .001). Forty percent of M2B prescriptions were adjusted before discharge because of financial or insurance barriers. M2B participants reported significantly less difficulty in obtaining medications compared with nonparticipants (1% vs 17%, P < .001).

CONCLUSIONS: The M2B program successfully increased parental report of timely administration of first home antimicrobial doses, a component of overall adherence. The program enabled providers to identify and resolve prescription problems before discharge. Importantly, caregivers reported reduced barriers to medication adherence.

  • Accepted June 1, 2020.
  • Copyright © 2021 by the American Academy of Pediatrics

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Pediatrics
Vol. 147, Issue 1
1 Jan 2021
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A Quality Improvement Initiative To Improve Postdischarge Antimicrobial Adherence
Sheena Gupta, Britanny Winckler, Michelle A. Lopez, Marco Costilla, Jennifer McCarthy, Jeffrey Wagner, Amanda Broderick, Katherine French, Brittany Le, Huay-ying Lo
Pediatrics Jan 2021, 147 (1) e20192413; DOI: 10.1542/peds.2019-2413

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A Quality Improvement Initiative To Improve Postdischarge Antimicrobial Adherence
Sheena Gupta, Britanny Winckler, Michelle A. Lopez, Marco Costilla, Jennifer McCarthy, Jeffrey Wagner, Amanda Broderick, Katherine French, Brittany Le, Huay-ying Lo
Pediatrics Jan 2021, 147 (1) e20192413; DOI: 10.1542/peds.2019-2413
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