Quality Improvement Initiative to Evaluate and Enhance Antibiotic Prescribing Practices in a Tertiary Care Children's Hospital in India

Abstract

Background: Infectious diseases remain a significant cause of morbidity and mortality worldwide, and antibiotics play a crucial role in their treatment. However, the inappropriate or irrational use of antibiotics leads to increased healthcare costs, adverse drug effects, and, most critically, the emergence of multidrug-resistant microorganisms, which has become a pressing global concern. To address this issue, we conducted a study at our hospital to evaluate the quality of antibiotic prescribing practices and to enhance the rational use of antibiotics in our pediatric medical unit.

Methods: This study was designed as a time-interrupted, non-randomized controlled trial conducted in a tertiary care children’s hospital in India. Data was collected from patients randomly selected from the Pediatric Outpatient Department (OPD) who were prescribed antibiotics for suspected bacterial infections. Only patients who had not received antibiotics from another health care provider for the current illness were included.

Antibiotic prescriptions were evaluated for adherence to existing guidelines and the quality of the prescription. A multidisciplinary quality improvement team, comprising faculty and residents from the Department of Pediatrics, was established to coordinate this initiative aimed at promoting the appropriate use of antibiotics.

Baseline analysis was done which was found to be sub-standard. Fishbone analysis was done to look for the causes. Plan-Do-Study-Act (PDSA) cycles were planned and conducted to increase the appropriate use of antibiotics. Three cycles were conducted over the period of next three months; which included conducting seminars, poster displays, and the distribution of mobile-friendly guideline documents. Compliance with the policy was tracked biweekly, and adherence to guidelines was recorded and analyzed over three months.

Results: We assessed 50 prescriptions over one month to evaluate the appropriateness of antibiotics prescribed. In the pre-intervention (baseline) phase, only 66.67% of cases adhered to the hospital's antibiotic policy. After collecting baseline data, the first Plan-Do-Study-Act (PDSA) cycle was conducted. Post-PDSA 1, the appropriateness of antibiotic prescriptions improved to 70.13%. However, this fell short of our target. Subsequently, a second PDSA cycle was implemented, following which, the appropriateness of antibiotic prescriptions increased to 94.7%, achieving our target. To assess sustained response PDSA cycle-3 was conducted, which showed remarkable increase of appropriateness to 100% at end of the four weeks.

Conclusions: Quality improvement methods, such as educational interventions, frequent reminders, and regular monitoring, significantly enhanced residents' awareness and improved their antibiotic prescribing practices. Sustained reinforcement and consistent monitoring are essential for the success of quality improvement initiatives and achieving the desired outcomes.

How to cite this article:
Kaur S, Singhal K K, Singh S, Quality Improvement Initiative to Evaluate and Enhance Antibiotic Prescribing Practices in a Tertiary Care Children’s Hospital in India. Postgrad J Pediatr Adol Med. 2026;3(1): 1-6.