Improving ototoxicity monitoring in patients receiving aminoglycosides using a novel digital approach: a quality improvement project
Aminoglycoside antibiotics cause ototoxicity for which baseline audiometric testing is recommended but often not done. Barriers to successful implementation include limited availability of sound-booths and audiologists. An ototoxicity monitoring programme (OMP) was implemented using tablet-based aud...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2025-04-01
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| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/14/2/e002847.full |
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| author | Andrew Jones Francis Drobniewski Michael Loebinger Emily Frost Julie Wilkins Presanna Premachandra Anand Shah Su Madge Nicholas J Simmonds Ricardo J José Jamie Cheong Shereen Boreland Elaine Shattock Elaine Bowman Barbara Belkarty Imogen Felton Emem-Fong Ukor Janet Stowell |
| author_facet | Andrew Jones Francis Drobniewski Michael Loebinger Emily Frost Julie Wilkins Presanna Premachandra Anand Shah Su Madge Nicholas J Simmonds Ricardo J José Jamie Cheong Shereen Boreland Elaine Shattock Elaine Bowman Barbara Belkarty Imogen Felton Emem-Fong Ukor Janet Stowell |
| author_sort | Andrew Jones |
| collection | DOAJ |
| description | Aminoglycoside antibiotics cause ototoxicity for which baseline audiometric testing is recommended but often not done. Barriers to successful implementation include limited availability of sound-booths and audiologists. An ototoxicity monitoring programme (OMP) was implemented using tablet-based audiometry (TBA) by non-audiologists.A quality improvement project conducted over 1 year (19 April 2021 to 18 April 2022), using Plan Do Study Act (PDSA) cycles, monitored the adherence to the OMP using Shoebox Standard Edition application on iPads. Barriers to adoption were identified to determine potential solutions for improved adherence. Adult respiratory patients (cystic fibrosis (CF), bronchiectasis, non-tuberculosis mycobacteria (NTM) infection) aged 17–82 years receiving >1 day of intravenous aminoglycosides (IVAGs) at a single tertiary-referral hospital were included. Other reported outcomes were patient characteristics, risk factors associated with abnormal hearing and ototoxic shift.73 patients were tested in the OMP (46 received ≥2 hearing tests) giving an overall adherence rate of 69% after 12 months. Patient identification using referral and reporting systems initially improved adherence from 36% to 88% (p=0.03) during PDSA 1. Barriers to successful adherence were staff availability and COVID-19 infection outbreaks (p=0.057). Older age (p<0.001), higher Body Mass Index (p=0.041), non-CF bronchiectasis (p=0.01), non-CF NTM (p=0.028) and higher Hearing Handicap Inventory for Adults scores (p=0.002) were significantly associated with abnormal baseline hearing. 78% with hearing loss were asymptomatic. Ototoxic shift was associated with gentamicin use compared to amikacin/tobramycin (p=0.027). TBA was associated with high usability in patients ≤50 years old.TBA by non-audiologists was feasible and demonstrated good patient usability, permitting screening of patients within 72 hours of starting IVAG and earlier referrals for formal audiometry. Hearing loss and ototoxicity were detected at earlier stages, enabling more rapid decision-making and treatment modification. |
| format | Article |
| id | doaj-art-ed3d1d55cc0c449e8c20db5611a7bb4b |
| institution | OA Journals |
| issn | 2399-6641 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Quality |
| spelling | doaj-art-ed3d1d55cc0c449e8c20db5611a7bb4b2025-08-20T02:27:28ZengBMJ Publishing GroupBMJ Open Quality2399-66412025-04-0114210.1136/bmjoq-2024-002847Improving ototoxicity monitoring in patients receiving aminoglycosides using a novel digital approach: a quality improvement projectAndrew Jones0Francis Drobniewski1Michael Loebinger2Emily Frost3Julie Wilkins4Presanna Premachandra5Anand Shah6Su Madge7Nicholas J Simmonds8Ricardo J José9Jamie Cheong10Shereen Boreland11Elaine Shattock12Elaine Bowman13Barbara Belkarty14Imogen Felton15Emem-Fong Ukor16Janet Stowell17Royal Brompton Hospital, London, UKImperial College London, London, UKRoyal Brompton Hospital, London, UKImperial College Healthcare NHS Trust, London, UKImperial College Healthcare NHS Trust, London, UKGuy`s and St Thomas’ NHS Foundation Trust, London, UKRoyal Brompton Hospital, London, UKRoyal Brompton Hospital, London, UKRoyal Brompton Hospital, London, UKRoyal Brompton Hospital, London, UKRoyal Brompton Hospital, London, UKRoyal Brompton Hospital, London, UKRoyal Brompton Hospital, London, UKRoyal Brompton Hospital, London, UKRoyal Brompton Hospital, London, UKRoyal Brompton Hospital, London, UKRoyal Brompton Hospital, London, UKRoyal Brompton Hospital, London, UKAminoglycoside antibiotics cause ototoxicity for which baseline audiometric testing is recommended but often not done. Barriers to successful implementation include limited availability of sound-booths and audiologists. An ototoxicity monitoring programme (OMP) was implemented using tablet-based audiometry (TBA) by non-audiologists.A quality improvement project conducted over 1 year (19 April 2021 to 18 April 2022), using Plan Do Study Act (PDSA) cycles, monitored the adherence to the OMP using Shoebox Standard Edition application on iPads. Barriers to adoption were identified to determine potential solutions for improved adherence. Adult respiratory patients (cystic fibrosis (CF), bronchiectasis, non-tuberculosis mycobacteria (NTM) infection) aged 17–82 years receiving >1 day of intravenous aminoglycosides (IVAGs) at a single tertiary-referral hospital were included. Other reported outcomes were patient characteristics, risk factors associated with abnormal hearing and ototoxic shift.73 patients were tested in the OMP (46 received ≥2 hearing tests) giving an overall adherence rate of 69% after 12 months. Patient identification using referral and reporting systems initially improved adherence from 36% to 88% (p=0.03) during PDSA 1. Barriers to successful adherence were staff availability and COVID-19 infection outbreaks (p=0.057). Older age (p<0.001), higher Body Mass Index (p=0.041), non-CF bronchiectasis (p=0.01), non-CF NTM (p=0.028) and higher Hearing Handicap Inventory for Adults scores (p=0.002) were significantly associated with abnormal baseline hearing. 78% with hearing loss were asymptomatic. Ototoxic shift was associated with gentamicin use compared to amikacin/tobramycin (p=0.027). TBA was associated with high usability in patients ≤50 years old.TBA by non-audiologists was feasible and demonstrated good patient usability, permitting screening of patients within 72 hours of starting IVAG and earlier referrals for formal audiometry. Hearing loss and ototoxicity were detected at earlier stages, enabling more rapid decision-making and treatment modification.https://bmjopenquality.bmj.com/content/14/2/e002847.full |
| spellingShingle | Andrew Jones Francis Drobniewski Michael Loebinger Emily Frost Julie Wilkins Presanna Premachandra Anand Shah Su Madge Nicholas J Simmonds Ricardo J José Jamie Cheong Shereen Boreland Elaine Shattock Elaine Bowman Barbara Belkarty Imogen Felton Emem-Fong Ukor Janet Stowell Improving ototoxicity monitoring in patients receiving aminoglycosides using a novel digital approach: a quality improvement project BMJ Open Quality |
| title | Improving ototoxicity monitoring in patients receiving aminoglycosides using a novel digital approach: a quality improvement project |
| title_full | Improving ototoxicity monitoring in patients receiving aminoglycosides using a novel digital approach: a quality improvement project |
| title_fullStr | Improving ototoxicity monitoring in patients receiving aminoglycosides using a novel digital approach: a quality improvement project |
| title_full_unstemmed | Improving ototoxicity monitoring in patients receiving aminoglycosides using a novel digital approach: a quality improvement project |
| title_short | Improving ototoxicity monitoring in patients receiving aminoglycosides using a novel digital approach: a quality improvement project |
| title_sort | improving ototoxicity monitoring in patients receiving aminoglycosides using a novel digital approach a quality improvement project |
| url | https://bmjopenquality.bmj.com/content/14/2/e002847.full |
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