The clinical value of PDCA cycle led by clinical pharmacists in optimizing the use of antimicrobial drugs in pediatric departments of primary hospitals.

BACKGROUND

Pediatric departments in primary hospitals face challenges such as insufficient diagnostic capabilities, weak management systems, and a lack of guidance on medication use. These factors have led to persistently high rates of antimicrobial use and misuse, which seriously jeopardize the safety of pediatric care in primary hospitals. Clinical pharmacists play a key role in ensuring the appropriate use of medications. However, in primary hospitals, their role is often marginalized or entirely absent.

OBJECTIVE

This study aims to evaluate the effectiveness of a multidisciplinary antimicrobial stewardship intervention led by clinical pharmacists in promoting the appropriate use of antimicrobials among pediatric outpatients and inpatients at a primary care hospital.

METHOD: This study established a multidisciplinary team led by clinical pharmacists and conducted a quality improvement study in the pediatric department of a primary care hospital. ChatGPT was introduced as a brainstorming tool during the root cause analysis process. Interventions included daily embedded ward rounds, electronic prescription preauthorization, and structured training. After two Plan-Do-Check-Act (PDCA) cycles, changes in primary and secondary outcome measures were compared between the control group and the two intervention groups.

RESULTS

After two PDCA cycles, the outpatient antimicrobial usage rate decreased from 38.81 to 27.14%, the intravenous infusion rate decreased from 28.29 to 20.04%, and the per-patient medication cost decreased from ¥68.50 to ¥49.73 (p < 0.0001). For inpatients, the antibiotic usage rate decreased from 90.92 to 78.36%, the antibiotic intensity decreased from 82.24 to 49.94, and the perpatient medication cost decreased from 281.94 Yuan to 130.90 Yuan (p < 0.0001). The rate of inappropriate prescribing among outpatients decreased from 34.75 to 12.08%, and among inpatients, it decreased from 40.30 to 13.42% (p < 0.0001). No statistically significant change was observed in the average length of hospital stay (p > 0.05). A standardized prescribing workflow was established.

CONCLUSION

Antimicrobial utilization decreased following implementation of the intervention. Tailored to the practical realities and characteristics of primary healthcare settings, it demonstrates both feasibility and replicability. It provides evidence-based guidance and a management framework for advancing rational drug use in children at the primary care level.