Chest X-rays (CXR), antibiotics and inhaled/nebulized therapy are overused in bronchiolitis, despite evidence-based guidelines suggesting supportive management only. This study investigates the effect of the implementation of the NICE bronchiolitis guideline in a secondary paediatric unit in England. We present a quality improvement project with a completed audit cycle (winter 2014-2015 and 2015-2016) pre- and post-implementation of the NICE bronchiolitis guideline. The educational intervention included sessions for raising awareness of appropriate and inappropriate management of bronchiolitis for both clinicians and nursing staff. As a result, the number of chest radiographs reduced fivefold (from 20 to 4% of patients, absolute reduction 16%), antibiotics reduced more than threefold (from 22 to 6% of patients, absolute reduction 16%) and inhaled/nebulised treatment up to twofold (from 30 to 16%, absolute reduction 14%). Overall NICE guideline compliance rose from 28 to 63%. CONCLUSION:Implementation of the NICE bronchiolitis guideline supported by a simple educational intervention can effectively reduce the number of inappropriate chest radiographs and antibiotic prescribing in bronchiolitis, and enhance compliance with the NICE guideline. What is Known: • Bronchiolitis management in paediatric units in the UK is variable, with poor evidence for existing guidance. Best available evidence was compiled into the NICE guideline, aiming to standardize care. • Some evidence exists for the effectiveness of quality improvement approaches to improve the management of bronchiolitis. What is New: • NICE guidance can be effectively applied to a department using simple educational tools. • Effective NICE implementation reduces the rates of unnecessary chest radiograph and antibiotic administration for patients admitted with bronchiolitis in District General Hospitals.

译文

尽管有基于证据的指南仅建议进行支持性治疗,但在细支气管炎中仍过度使用胸腔X射线(CXR),抗生素和吸入/雾化疗法。这项研究调查了在英格兰的第二小儿科医院实施NICE细支气管炎指南的效果。我们提出了一个质量改进项目,在执行之前和之后执行NICE毛细支气管炎指南的审核周期均已完成(2014-2015年冬季和2015-2016年冬季)。该教育干预措施包括提高临床医生和护理人员对毛细支气管炎适当和不适当处理的认识的课程。结果,胸部X光片数量减少了五倍(从20%减少到4%的患者,绝对减少了16%),抗生素减少了三倍以上(从22%减少到6%的患者,绝对减少了16%),并且采用了吸入/雾化治疗高达两倍(从30%到16%,绝对减少14%)。 NICE指南的总体合规率从28%上升到63%。
结论:通过简单的教育干预措施来实施NICE细支气管炎指南可有效减少细支气管炎的胸部X光片和抗生素处方的使用,并提高对NICE指南的依从性。众所周知:•英国小儿毛细支气管炎的治疗方法不一,现有指南的证据不充分。 NICE指南中汇集了最佳的可用证据,旨在使护理标准化。 •有一些证据表明质量改进方法可改善毛细支气管炎的治疗效果。新增功能:•NICE指南可以使用简单的教育工具有效地应用于部门。 •有效的NICE实施降低了地区综合医院收治的细支气管炎患者不必要的胸部X光检查和抗生素管理的比例。

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