An interdisciplinary student-led multifaceted intervention addressing overuse of broad-spectrum antibiotics for patients with penicillin allergies.

BACKGROUND: Though 15% of hospitalized patients have a documented penicillin (PCN) allergy, fewer than 1% have an IgE-mediated reaction that necessitates avoidance of ß-lactam antibiotics. OBJECTIVE: Our interdisciplinary team of medical and nursing students led and executed a two-pronged quality improvement intervention to reduce prescribing of non-ß-lactam antibiotics (NBLs) for patients with reported PCN allergies. To the best of our knowledge, this is the first multidisciplinary student-led intervention aimed at educating providers on low-risk penicillin allergy and encouraging best antibiotic prescribing practices. DESIGN AND PARTICIPANTS: The intervention took place from June 2021 to February 2022. We developed and provided clinician education modules, including peer-to-peer information sharing and in-person small group discussions, as well as clinical decision support (CDS) strategies through the electronic medical record (EMR). The target population was attendings, residents, nurse practitioners, and physician assistants on the hospital medicine service at a large urban academic tertiary care center. We followed the SQUIRE 2.0 guidelines for reporting on quality improvement. MAIN MEASURES: Primary outcome measures included number of NBL prescriptions and use of nonspecific descriptors (e.g., "other" or "unknown") for PCN allergy reaction type, and were compared with a pre-intervention period. KEY RESULTS: The percent of ß-lactam prescriptions for patients with a PCN allergy after the intervention increased from 19 to 23% (p = 0.006). For patients with a low severity PCN allergy, the percent of ß-lactam prescriptions increased from 20 to 28% (p = 0.001). There was a significant decrease in nonspecific PCN allergy reaction type from 23% in the pre-intervention period to 20% post-intervention (p = 0.012). CONCLUSIONS: An intervention focused on educating prescribers and CDS strategies delivered through the EMR increased appropriate ß-lactam prescribing for patients with a documented low-risk PCN allergy and reduced the use of nonspecific PCN allergy reaction type in EMR documentation.

The Relationship Between Parenting Styles Practiced By Grandparents And Children's Emotional And Behavioral Problems.

Objectives: To examine the relationship between grandparenting styles and grandchildren's emotions and behaviors, while controlling for parenting styles, and to compare the effects of grandparenting styles and parenting styles on children's behavioral problems in China. Methods: A sample of 765 children, with a mean age of 12.02 years (SD = 0.38), participated in this cross-sectional study in Jintan city, Jiangsu province, China. All participants completed the self-report measures of emotions and behaviors, grandparenting styles, and sociodemographic variables. Results: Results showed that the well-recognized parenting styles (Care, Indifference, Overprotection, and Autonomy), when implemented by grandparents (grandparenting styles) and parents (parenting styles), had different patterns of effects on children's emotional and behavioral problems. Grandparenting styles, especially grandparental Care and Overprotection, were positively related to emotional and behavioral problems, while parental Care was negatively related to children's externalizing behaviors. Conclusions: These results highlight the importance of grandparenting styles in grandchildren's development. Practitioners working with grandparents and grandchildren need to recognize the complexity of grandparent-grandchild relationships and implement suitable interventions to meet the family needs.