A Prospective Interventional Study on the Application of Lean Six Sigma DMAIC Methodology on Assessing and Improving Antimicrobial Stewardship in a Tertiary Trauma Care Hospital, Coimbatore, India

Background: Antimicrobial stewardship is referred as a concerted endeavor to ensure proper usage of antibiotics and deviations in programme leads to inappropriate use of antimicrobials, hence it requires standard tool to evaluate usage and measure improvement by alleviating deviations. The objective of the study is to observe antimicrobial stewardship activities in surgical patients and to develop comparison between antimicrobial recommending techniques with standard guideline available within hospital. To identify suitable variables or factors to measure antimicrobial stewardship and thereby accomplish recommendations for rational use of antimicrobials. Materials and Methods: The study was conducted in the department of orthopedics and plastic surgery, in a major trauma care centre in Tamil Nadu, India over a period of two years. The study was performed by using lean six sigma DMAIC tool. Results: In the current study, implementation of Lean Six Sigma DMAIC methodology revealed significant decrease in guideline errors, irregular follow ups, improper antibiotic usage and prescribing errors. Correspondingly, Six Sigma level improved from 1.1, 2.47, 3.87, 3.35 to 1.57, 2.55, 4.02 and 3.61 respectively. Conclusion: The study concluded that, by reducing antibiotic associated errors, such as inappropriate usage of antibiotics, prophylaxis use of higher end antibiotics, unrestricted duration of use and economic burden related to antibiotic treatment can be reduced. This can have a direct impact on improving patient safety and better clinical outcome.