title: Rapid adoption of Lactobacillus rhamnosus GG for acute gastroenteritis.
abstract: OBJECTIVE
  A 2007 meta-analysis showed probiotics, specifically Lactobacillus rhamnosus GG (LGG), shorten diarrhea from acute gastroenteritis (AGE) by 24 hours and decrease risk of progression beyond 7 days. In 2005, our institution published a guideline recommending consideration of probiotics for patients with AGE, but only 1% of inpatients with AGE were prescribed LGG. The objective of this study was to increase inpatient prescribing of LGG at admission to >90%, for children hospitalized with AGE, within 120 days.
  
  
  METHODS
  This quality improvement study included patients aged 2 months to 18 years admitted to general pediatrics with AGE with diarrhea. Diarrhea was defined as looser or ≥ 3 stools in the preceding 24 hours. Patients with complex medical conditions or with presumed bacterial gastroenteritis were excluded. Admitting and supervising clinicians were educated on the evidence. We ensured LGG was adequately stocked in our pharmacies and updated an AGE-specific computerized order set to include a default LGG order. Failure identification and mitigation were conducted via daily electronic chart review and e-mail communication. Primary outcome was the percentage of included patients prescribed LGG within 18 hours of admission. Intervention impact was assessed with run charts tracking our primary outcome over time.
  
  
  RESULTS
  The prescribing rate increased to 100% within 6 weeks and has been sustained for 7 months.
  
  
  CONCLUSIONS
  Keys to success were pharmacy collaboration, use of an electronic medical record for a standardized order set, and rapid identification and mitigation of failures. Rapid implementation of evidence-based practices is possible using improvement science methods.
authors: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 3024, Cincinnati, OH 45229-3039, USA. michelle.parker@cchmc.org
authors: Michelle W
authors: MW
authors: Parker
authors: Joshua K
authors: JK
authors: Schaffzin
authors: Andrea
authors: A
authors: Lo Vecchio
authors: Connie
authors: C
authors: Yau
authors: Karen
authors: K
authors: Vonderhaar
authors: Amy
authors: A
authors: Guiot
authors: William B
authors: WB
authors: Brinkman
authors: Christine M
authors: CM
authors: White
authors: Jeffrey M
authors: JM
authors: Simmons
authors: Wendy E
authors: WE
authors: Gerhardt
authors: Uma R
authors: UR
authors: Kotagal
authors: Patrick H
authors: PH
authors: Conway
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000628:therapy*; D004059:Diffusion of Innovation; D019317:Evidence-Based Medicine; D005759:Gastroenteritis / Q000628:therapy*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D052201:Lacticaseibacillus rhamnosus; D050316:Medical Order Entry Systems; D009820:Ohio; D009936:Organizational Innovation; D010607:Pharmacy Service, Hospital; D019936:Probiotics / Q000627:therapeutic use*; D058996:Quality Improvement