Plan-do-check-act (PDCA) cycle analysis for antimicrobial stewardship of orthopedic patients in trauma center—implementation research

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Objective: The current study was done to evaluate the impact of a plan-do-check-act (PDCA)-based AMS program implemented at a tertiary trauma center. Setting/Patients: Inpatients admitted to an Advanced Trauma Centre of a tertiary care hospital in North India. Methods: This implementation research study was conducted in four phases from March 2019 to November 2024. The AMS strategies included prospective audits, feedback mechanisms, education, and multidisciplinary collaboration. Descriptive statistics were used for antibiotic prescription practices, adherence to guidelines, and patient outcomes. Metrics for antibiotics utilization and appropriateness of prescription were the key performance indicators analyzed. Results: A total of 767 patients were enrolled during this period. The practice of antibiotic prescription changed from being prophylactic to culture-based-increasing from 0.7% in phase 1 to 21.4% in phase 4. Compliance to feedback increased from 75.8% in phase 3 to 90.7% in phase 4. There was a fall in aggregate defined daily dose to 658.4, from 808.2 per 1000 patient days, and length of therapy also improved. There was a marked increase in the number of culture-based interventions. The educational programs and multidisciplinary team rounds further reinforced the practice of AMS. Conclusions: The PDCA cycle significantly improved the use of antimicrobials, adherence to treatment guidelines, and patient outcomes in a resource-constrained setting. This approach provides a scalable model for implementing AMS in surgical units despite challenges such as limited microbiological resources.

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