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Optimizing Antibiotic Stewardship in California NICUs

The Optimizing Antibiotic Stewardship in California NICUs (OASCN) Collaborative was active from March 2021 – February 2023.

The Optimizing Antibiotic Stewardship in California NICUs (OASCN) Collaborative aimed to scale up dissemination of various nationally recommended interventions to improve antimicrobial stewardship among NICUs in California using a blended QI collaborative and ECHO™ (Extension for Community Healthcare Outcomes) tele-learning model. ECHO™ is an evidence-based, American Academy of Pediatrics-endorsed method of practice dissemination used globally that focuses on faculty-facilitated, case-based learning tailored to how clinicians are inclined to learn and build practice consensus. QI collaboratives, while similarly including faculty facilitation and peer-learning, focus on supporting continuous quality improvement efforts by site implementation teams. OASCN was supported by a grant from the Agency for Healthcare Research and Quality (AHRQ Grant# R18HS26168-01A1) to implement and evaluate the collaborative.

   OASCN Resource Bundle 

Why we care about this topic

We all would like to evolve our practice towards the safest and most appropriate use of antibiotics for our newborns. Unnecessary and/or inappropriate antibiotic use continues to be a problem in the NICU setting with the potential for harm to neonates. At the same time, professional associations, accreditors, and ongoing national initiatives highlight the increasing urgency of antimicrobial resistance and stewardship.

Our approach

We designed this collaborative with partners at the RAND Corporation and The Lundquist Institute at Harbor-UCLA Medical Center in Los Angeles to include the latest in collaborative learning approaches. OASCN began with 31 California NICUs and hosted Learning Sessions open to all NICU clinical staff via Zoom every 2 weeks from early March 2021 through February 2022 and quarterly thereafter until February 2023. Other collaborative activities and supports included a Learning Points recap email after each biweekly session, a collaborative email listserv and filesharing site, and an online data submission and QI analytics portal. The primary goal of the OASCN Collaborative was to safely reduce antibiotic usage rate (AUR) for all infants at participating NICUs. Participating NICUs selected which gestational ages to focus their improvement efforts (e.g. preterm, late preterm, term babies).

Benefits of this collaborative included

  • Participation in interactive, case-based learning sessions guided by a multidisciplinary faculty panel on NICU antibiotic prescribing
  • Sharing experiences and lessons with NICUs across the state on optimizing antibiotic use
  • Learning and applying principles of implementing quality improvement
  • Reducing antibiotic utilization

OASCN Faculty Panel, Learning Team, and Evaluation Team

The following team members comprised the OASCN Faculty Panel, Learning Team, and Evaluation Team in 2021-2023.
Alice Pong, MD, Rady Children’s
Bill Benitz, MD, Stanford University
Courtney Armstrong, MPH, RAND Corporation
Cynthia Gong, PharmD, PhD, USC
Henry Lee, MD, MS, CPQCC
Irineo Cabreros, PhD, RAND Corporation
Jack Kroger, MSc, RAND Corporation
Janine Bohnert, BS, CPQCC
Jason Sauberan, PharmD, Rady Children’s
Joseph Schulman, MD, MS, California Children’s Services (CCS)
Ken Zangwill, MD, The Lundquist Institute at Harbor-UCLA Medical Center
Kristen Schaffer, MPH, CPQCC
Kurlen Payton, MD, Cedars-Sinai Medical Center
Lillian Sie, MPH, CPQCC
Linda Lefrak, MSN, RN, California Department of Public Health
Megan Schuler, PhD, RAND Corporation
Michael Bolaris, MD, Harbor-UCLA Medical Center
Nabeel Qureshi, MPH, RAND Corporation
Peter Mendel, PhD, RAND Corporation
Victor Wong, MD, Kaiser Permanente

Participating Centers

California Pacific Medical Center
Cedars-Sinai Medical Center, Los Angeles
Children's Hospital of Orange County (CHOC)
Community Memorial Hospital 
Desert Regional Medical Center
Dignity Health Saint Bernardine Medical Center
Good Samaritan Hospital, San Jose
Kaiser Permanente Baldwin Park Medical Center
Kaiser Permanente Medical Center Irvine 
Kaiser Permanente Riverside Medical Center
Kaiser Permanente San Diego Medical Center
Kaiser Permanente West Los Angeles 
KFH Orange County - Anaheim
KFH Panorama City
KFH South Bay
LPCH NICU at Sequoia
Mercy San Juan Medical Center
Northridge Hospital Medical Center
O'Connor Hospital
Orange County Global Medical Center
Parkview Community Hospital Medical Center
PIH Health Good Samaritan Hospital, Los Angeles
Rady Children's Rancho Springs NICU
Riverside University Health System - Medical Center
Salinas Valley Memorial Hospital 
Santa Clara Valley Medical Center
St. Francis Medical Center
UCI Medical Center
UCSD - Jacobs Medical Center
Watsonville Community Hospital

Related Publication: Blood culture procedures and practices in the neonatal intensive care unit: A survey of a large multicenter collaborative in California