Pediatrics faculty members at the University of Florida College of Medicine – Jacksonville are among those involved in award-winning measures taken to significantly improve patient care in UF Health Jacksonville’s Neonatal Intensive Care Unit.
The NICU is the recipient of the 2019 John Curran Quality Improvement Award. The accolade recognizes a Florida hospital that has made measurable and sustained positive change in a major perinatal quality assessment metric through the implementation of several best clinical practices.
The Florida Perinatal Quality Collaborative bestowed the award based on compelling results of a multidisciplinary quality improvement initiative led by neonatologist Josef Cortez, MD, an assistant professor of pediatrics at UF COMJ and medical director of the NICU at UF Health Jacksonville. The project — “Creating an Antibiotic Stewardship Program in a Tertiary Neonatal Intensive Care Unit: Charge Nurses Taking Charge” — mobilized the entire team to use antibiotics more judiciously and, as a byproduct, led to a reduction in central line infections.
William Sappenfield, MD, MPH, director of the Florida Perinatal Quality Collaborative, complimented the team’s rigorous, sequential and successful use of the Plan-Do-Study-Act, or PDSA, research approach.
“Your write-up was stellar, demonstrating a measurable objective, using PDSA cycles to identify and implement positive change, making multiple necessary changes and clearly demonstrating measurable results,” Sappenfield said. “Congratulations to all.”
Enhancing processes, improving care
UF Health Jacksonville is a member of the Vermont Oxford Network, or VON, which — along with the Centers for Disease Control and Prevention — launched “Choosing Antibiotics Wisely” in 2016. The internet-based, multicenter collaborative aims to curb nonjudicious use of antibiotics in newborn medicine.
That same year, UF Health Jacksonville created its antibiotic stewardship program in the NICU and began tracking the antibiotic usage rate, or AUR. The team implemented sequential PDSA cycles to reduce unnecessary antibiotic treatment and evaluated the success of this goal in real time by tracking the AUR. Initially it decreased, as hoped. When the AUR later increased, the team instituted other practices that reduced central line infections and once again decreased the rate.
“Although AUR was our primary outcome measure, we hoped to instill a culture of more judicious antibiotic prescription, to decrease central line infections, to engage charge nurses and parents, and to challenge the standard practice of continuing antibiotics in tiny babies who had no evidence of actual infection,” Cortez said.
Follow this link to view the project in its entirety.
Medical Director, Neonatal Intensive Care Unit
Chair, Department of Pediatrics; Chief, Division of Neonatology; Interim Chief, Division of Rheumatology, Interim Chief, Division of Nephrology; Associate Director NICU Wolfson Children's Hospital; Associate Dean for Managed Care