Development of an Electronic Algorithm to Target Outpatient Antimicrobial Stewardship Efforts for Acute Bronchitis

Background: Antibiotic resistance has increased at alarming rates, driven predominantly by antibiotic overuse. Although most antibiotic use occurs in outpatients, antimicrobial stewardship programs have primarily focused on inpatient settings. A major challenge for outpatient stewardship is the lack of accurate and accessible electronic data to target interventions. We sought to develop and validate an electronic algorithm to identify inappropriate antibiotic use for outpatients with acute bronchitis. Methods: This study was conducted within the University of Pennsylvania Health System (UPHS). We used ICD-10 diagnostic codes to identify encounters for acute bronchitis at any outpatient UPHS practice between March 15, 2017, and March 14, 2018. Exclusion criteria included underlying immunocompromising condition, other comorbidity influencing the need for antibiotics (eg, emphysema), or ICD-10 code at the same visit for a concurrent infection (eg, sinusitis). We randomly selected 300 (150 from academic practices and 150 from nonacademic practices) eligible subjects for detailed chart abstraction that assessed patient demographics and practice and prescriber characteristics. Appropriateness of antibiotic use based on chart review served as the gold standard for assessment of the electronic algorithm. Because antibiotic use is not indicated for this study population, appropriateness was assessed based upon whether an antibiotic was prescribed or not. Results: Of 300 subjects, median age was 61 years (interquartile range, 50–68), 62% were women, 74% were seen in internal medicine (vs family medicine) practices, and 75% were seen by a physician (vs an advanced practice provider). On chart review, 167 (56%) subjects received an antibiotic. Of these subjects, 1 had documented concern for pertussis and 4 had excluding conditions for which there were no ICD-10 codes. One received an antibiotic prescription for a planned dental procedure. Thus, based on chart review, 161 (54%) subjects received antibiotics inappropriately. Using the electronic algorithm based on diagnostic codes, underlying and concurrent conditions, and prescribing data, the number of subjects with inappropriate prescribing was 170 (56%) because 3 subjects had antibiotic prescribing not noted based on chart review. The test characteristics of the electronic algorithm (compared to gold standard chart review) for identification of inappropriate antibiotic prescribing were the following: sensitivity, 100% (161 of 161); specificity, 94% (130 of 139); positive predictive value, 95% (161 of 170); and negative predictive value, 100% (130 of 130). Conclusions: For outpatients with acute bronchitis, an electronic algorithm for identification of inappropriate antibiotic prescribing is highly accurate. This algorithm could be used to efficiently assess prescribing among practices and individual clinicians. The impact of interventions based on this algorithm should be tested in future studies.Funding: NoneDisclosures: None

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Development of an Electronic Algorithm to Identify Inappropriate Antibiotic Prescribing for Pediatric Pharyngitis

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.728 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s188-s189

Author(s):

Jeffrey Gerber ◽

Robert Grundmeier ◽

Keith Hamilton ◽

Lauri Hicks ◽

Melinda Neuhauser ◽

...

Keyword(s):

Predictive Value ◽

Gold Standard ◽

Antibiotic Stewardship ◽

Chart Review ◽

Antibiotic Use ◽

Audit And Feedback ◽

Urgent Care ◽

Antibiotic Prescribing ◽

Tract Infections ◽

The Impact

Background: Antibiotic overuse contributes to antibiotic resistance and unnecessary adverse drug effects. Antibiotic stewardship interventions have primarily focused on acute-care settings. Most antibiotic use, however, occurs in outpatients with acute respiratory tract infections such as pharyngitis. The electronic health record (EHR) might provide an effective and efficient tool for outpatient antibiotic stewardship. We aimed to develop and validate an electronic algorithm to identify inappropriate antibiotic use for pediatric outpatients with pharyngitis. Methods: This study was conducted within the Children’s Hospital of Philadelphia (CHOP) Care Network, including 31 pediatric primary care practices and 3 urgent care centers with a shared EHR serving >250,000 children. We used International Classification of Diseases, Tenth Revision (ICD-10) codes to identify encounters for pharyngitis at any CHOP practice from March 15, 2017, to March 14, 2018, excluding those with concurrent infections (eg, otitis media, sinusitis), immunocompromising conditions, or other comorbidities that might influence the need for antibiotics. We randomly selected 450 features for detailed chart abstraction assessing patient demographics as well as practice and prescriber characteristics. Appropriateness of antibiotic use based on chart review served as the gold standard for evaluating the electronic algorithm. Criteria for appropriate use included streptococcal testing, use of penicillin or amoxicillin (absent β-lactam allergy), and a 10-day duration of therapy. Results: In 450 patients, the median age was 8.4 years (IQR, 5.5–9.0) and 54% were women. On chart review, 149 patients (33%) received an antibiotic, of whom 126 had a positive rapid strep result. Thus, based on chart review, 23 subjects (5%) diagnosed with pharyngitis received antibiotics inappropriately. Amoxicillin or penicillin was prescribed for 100 of the 126 children (79%) with a positive rapid strep test. Of the 126 children with a positive test, 114 (90%) received the correct antibiotic: amoxicillin, penicillin, or an appropriate alternative antibiotic due to b-lactam allergy. Duration of treatment was correct for all 126 children. Using the electronic algorithm, the proportion of inappropriate prescribing was 28 of 450 (6%). The test characteristics of the electronic algorithm (compared to gold standard chart review) for identification of inappropriate antibiotic prescribing were sensitivity (99%, 422 of 427); specificity (100%, 23 of 23); positive predictive value (82%, 23 of 28); and negative predictive value (100%, 422 of 422). Conclusions: For children with pharyngitis, an electronic algorithm for identification of inappropriate antibiotic prescribing is highly accurate. Future work should validate this approach in other settings and develop and evaluate the impact of an audit and feedback intervention based on this tool.Funding: NoneDisclosures: None

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151. An Electronic Algorithm to Better Target Antimicrobial Stewardship Program (ASP) Efforts for Children Hospitalized with Community-Acquired Pneumonia (CAP)

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.196 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S85-S86

Author(s):

Jeffrey Gerber ◽

Robert Grundmeier ◽

Keith W Hamilton ◽

Lauri Hicks ◽

Melinda M Neuhauser ◽

...

Keyword(s):

Chart Review ◽

Inappropriate Prescribing ◽

Antibiotic Use ◽

Community Acquired Pneumonia ◽

Duration Of Therapy ◽

Test Characteristics ◽

Diagnostic Codes ◽

Stewardship Program ◽

Icd 10 ◽

The Impact

Abstract Background Pediatric antibiotic stewardship programs (ASPs) have been successful in decreasing inappropriate antibiotic use. However, they require considerable time and effort. Approaches to increase ASP efficiency are urgently needed. We developed and validated an electronic algorithm to identify inappropriate antibiotic use in children hospitalized with community-acquired pneumonia (CAP). Methods At Children’s Hospital of Philadelphia (CHOP), we used ICD-10 diagnostic codes to identify inpatient patient encounters for pneumonia between 3/15/17 – 3/14/18 for which patients received a systemic antibiotic in the first 48 hours of hospitalization. Exclusion criteria included transfer from another facility, intensive care unit admission or death in first 48 hours, immunocompromising condition, or specific comorbidities. We randomly selected 150 subjects. Inappropriate antibiotic use based on chart review served as the basis for assessment of the electronic algorithm which was constructed using only data in the electronic health record (EHR). Criteria for appropriate prescribing, choice of antibiotic, and duration of therapy were based on established CHOP and IDSA/PIDS guidelines. Results Of 148 eligible subjects, median age was 3.8, 48% were female, and 129 (86%) were admitted to a general pediatrics service. On chart review, 147 (99%) subjects were correctly diagnosed with CAP. Of these subjects, the choice of initial antibiotic(s) was appropriate in 133 (90%). Of the 147 subjects, 137 (93%) had an appropriate duration of therapy. Test characteristics of the EHR algorithm (compared to chart review) are noted in the Table. Conclusion In pediatric patients hospitalized with CAP, the electronic algorithm for identifying inappropriate prescribing, antibiotic choice, and duration was highly accurate. This algorithm could have considerable utility in targeting ASP initiatives. The impact of interventions based on this algorithm should be tested in the future Test Characteristics of Electronic Algorithm for Inappropriate Prescribing, Agent, and Duration Disclosures All Authors: No reported disclosures

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229. Hospitalists Antimicrobial Scorecard Improves Antibiotic Prescribing at a Community Teaching Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.273 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S116-S116

Author(s):

Julia Sessa ◽

Helen Jacoby ◽

Bruce Blain ◽

Lisa Avery

Keyword(s):

Patient Care ◽

Teaching Hospital ◽

Antimicrobial Stewardship ◽

Rank Order ◽

Antibiotic Use ◽

Outpatient Setting ◽

Antibiotic Prescribing ◽

Full Time ◽

Days Of Therapy ◽

The Impact

Abstract Background Measuring antimicrobial consumption data is a foundation of antimicrobial stewardship programs. There is data to support antimicrobial scorecard utilization to improve antibiotic use in the outpatient setting. There is a lack of data on the impact of an antimicrobial scorecard for hospitalists. Our objective was to improve antibiotic prescribing amongst the hospitalist service through the development of an antimicrobial scorecard. Methods Conducted in a 451-bed teaching hospital amongst 22 full time hospitalists. The antimicrobial scorecard for 2019 was distributed in two phases. In October 2019, baseline antibiotic prescribing data (January – September 2019) was distributed. In January 2020, a second scorecard was distributed (October – December 2019) to assess the impact of the scorecard. The scorecard distributed via e-mail to physicians included: Antibiotic days of therapy/1,000 patient care days (corrected for attending census), route of antibiotic prescribing (% intravenous (IV) vs % oral (PO)) and percentage of patients prescribed piperacillin-tazobactam (PT) for greater than 3 days. Hospitalists received their data in rank order amongst their peers. Along with the antimicrobial scorecard, recommendations from the antimicrobial stewardship team were included for hospitalists to improve their antibiotic prescribing for these initiatives. Hospitalists demographics (years of practice and gender) were collected. Descriptive statistics were utilized to analyze pre and post data. Results Sixteen (16) out of 22 (73%) hospitalists improved their antibiotic prescribing from pre- to post-scorecard (χ 2(1)=3.68, p = 0.055). The median antibiotic days of therapy/1,000 patient care days decreased from 661 pre-scorecard to 618 post-scorecard (p = 0.043). The median PT use greater than 3 days also decreased significantly, from 18% pre-scorecard to 11% post-scorecard (p = 0.0025). There was no change in % of IV antibiotic prescribing and no correlation between years of experience or gender to antibiotic prescribing. Conclusion Providing antimicrobial scorecards to our hospitalist service resulted in a significant decrease in antibiotic days of therapy/1,000 patient care days and PT prescribing beyond 3 days. Disclosures All Authors: No reported disclosures

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154. Development of an Electronic Algorithm to Target Outpatient Antimicrobial Stewardship Efforts for Adults with Acute Pharyngitis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.199 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S87-S87

Author(s):

Ebbing Lautenbach ◽

Keith W Hamilton ◽

Robert Grundmeier ◽

Melinda M Neuhauser ◽

Lauri Hicks ◽

...

Keyword(s):

Chart Review ◽

Inappropriate Prescribing ◽

Antibiotic Use ◽

University Of Pennsylvania ◽

Antibiotic Prescribing ◽

Acute Pharyngitis ◽

Test Characteristics ◽

Appropriate Prescribing ◽

Concurrent Infections ◽

The Impact

Abstract Background Although most antibiotic use occurs in outpatients, antibiotic stewardship programs (ASPs) have primarily focused on inpatients. A major challenge for outpatient ASPs is lack of accurate and accessible electronic data to target interventions. We developed and validated an electronic algorithm to identify inappropriate antibiotic use for adult outpatients with acute pharyngitis. Methods In the University of Pennsylvania Health System, we used ICD-10 diagnostic codes to identify patient encounters for acute pharyngitis at outpatient practices between 3/15/17 – 3/14/18. Exclusion criteria included immunocompromising conditions, comorbidities, and concurrent infections that might require antibiotic use. We randomly selected 300 eligible subjects. Inappropriate antibiotic use based on chart review served as the basis for assessment of the electronic algorithm which was constructed using only data in the electronic health record (EHR). Criteria for appropriate prescribing, choice of antibiotic, and duration included positive streptococcal testing, use of penicillin/amoxicillin (absent b-lactam allergy), and 10 days maximum duration of therapy. Results Of 300 subjects, median age was 42, 75% were female, 64% were seen by internal medicine (vs. family medicine), and 69% were seen by a physician (vs. advanced practice provider). On chart review, 127 (42%) subjects received an antibiotic, of which 29 had a positive streptococcal test and 4 had another appropriate indication. Thus, 74% (94/127) of patients received antibiotics inappropriately. Of the 29 patients who received appropriate prescribing, 27 (93%) received an appropriate antibiotic. Finally, of the 29 patients who were appropriately treated, 29 (100%) received the correct duration. Test characteristics of the EHR algorithm (compared to chart review) are noted in the Table. Conclusion Inappropriate antibiotic prescribing for acute pharyngitis is common. An electronic algorithm for identifying inappropriate prescribing, antibiotic choice, and duration is highly accurate. This algorithm could be used to efficiently assess prescribing among practices and individual clinicians. The impact of interventions based on this algorithm should be tested in future work. Test Characteristics of Electronic Algorithm for Inappropriate Prescribing, Agent, and Duration Disclosures All Authors: No reported disclosures

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Pharmacy-Based Intervention to Reduce Antibiotic Use for Acute Bronchitis

Annals of Pharmacotherapy ◽

10.1177/106002800303700204 ◽

2003 ◽

Vol 37 (2) ◽

pp. 187-191 ◽

Cited By ~ 10

Author(s):

David E Hickman ◽

Marilyn R Stebbins ◽

John R Hanak ◽

B Joseph Guglielmo

Keyword(s):

Intervention Program ◽

Acute Bronchitis ◽

Antibiotic Use ◽

Urgent Care ◽

Antibiotic Prescribing ◽

Group Model ◽

Community Based ◽

Health Maintenance ◽

Physician Group ◽

The Impact

BACKGROUND: Intervention programs can reduce inappropriate antibiotic use for the treatment of acute bronchitis in a closed health maintenance organization model. OBJECTIVE: To evaluate the impact of a pharmacy-based intervention program intended to reduce antibiotic use in the treatment of acute bronchitis in a community-based physician group model. SUBJECTS: Adult and pediatric patients with an office or urgent care visit for acute bronchitis during the baseline and study periods were included in the study. The clinicians were primary care physicians, nurse practitioners, and physician assistants in a suburban community-based physician group setting. METHODS: All patients treated for acute bronchitis from January 1 through June 30, 1998, were evaluated for initial receipt of antibiotics and use of clinic resources (office visits, additional antibiotics). From September through December of 1998, physicians were provided literature from the Centers for Disease Control and Prevention (CDC), cough and cold package inserts, and newsletters intended to educate the providers regarding the inappropriateness of antibiotics in the treatment of acute bronchitis. Patient-directed literature from the CDC was placed in the examination rooms and clinic waiting areas beginning September 1998. From January 1 through June 30, 1999, all patients treated for acute bronchitis were assessed for receipt of antibiotics and use of clinic resources. A separate geographic clinic site served as a control during both study periods. RESULTS: During 1998, 888 of 1840 patients (48.3%) received antibiotics for treatment of acute bronchitis; this total decreased to 924 of 2392 (38.6%; p ≤ 0.001) in 1999, a reduction of 20%. The rate of antibiotic prescribing in control patients was unchanged during the concomitant time periods (142/446, 31.8% vs. 102/321, 31.8%). The rate of subsequent physician visits was similar (8% vs. 9%) between patients receiving antibiotics and those who did not. However, significantly more patients initially receiving antibiotics required a subsequent antibiotic prescription (45/1812, 2.5% vs. 24/2420, 1.0%; p ≤ 0.001). CONCLUSIONS: A pharmacy-based intervention program reduces the incidence of inappropriate antibiotic use in the treatment of acute bronchitis. Reduced antibiotic prescribing does not increase consumption of healthcare resources; patients who receive antibiotics for acute bronchitis are more likely to subsequently require additional antibiotic prescriptions. While a significant decrease in antibiotic use was realized, other interventions are required to further reduce the prevalence of antibiotic use in acute bronchitis.

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2075. Transforming Outpatient Antimicrobial Stewardship Through a Clinical Surveillance System

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1755 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S699-S700

Author(s):

David B Portman ◽

Victoria M Pattison

Keyword(s):

Antimicrobial Stewardship ◽

Surveillance System ◽

Chart Review ◽

Performance Metrics ◽

Outpatient Setting ◽

Direct Approach ◽

Antibiotic Prescribing ◽

Clinical Surveillance ◽

The Impact

Abstract Background Multiple studies have highlighted the predominance of inappropriate antibiotic prescribing in the outpatient setting, thus making an area ripe for antimicrobial stewardship interventions. One way to identify intervention opportunities and monitor performance metrics is through utilization of a clinical surveillance system (CSS). Methods In October 2017, TheraDoc (DSS Inc.) was obtained which serves as a CSS. Upon installation, the antimicrobial stewardship committee designed the alerts found in Figure 1 that would be utilized to identify potential interventions. Alerts that were deemed to be of high value or time sensitive were to be emailed to pharmacists involved with antimicrobial stewardship. It was theorized that this method would help transform outpatient antimicrobial stewardship from a predominately retrospective approach, to a prospective approach. Outpatient stewardship metrics were compared for pre- and post-CSS implementation to evaluate the impact of a CSS. The pre-implementation group (PreCSS) represented outpatient stewardship interventions that occurred January 2017 through June 2017 where all antibiotic prescriptions were reviewed. The post-implementation group (PostCSS) represented outpatient stewardship interventions that occurred April 2018 through September 2018 which were predominantly driven by CSS alerts. Results The PostCSS group had substantially fewer charts reviewed compared with the PreCSS group (267 vs. 1,415). In addition, the PostCSS group completed 77.6% more interventions compared with the PreCSS group (87 vs. 49). Thirty-one less charts were reviewed per one intervention, which led to 469 less minutes of chart review per one intervention. See Figure 2 for list of interventions. The PostCSS group received a significant increase in consults due to the direct approach to interventions compared with the PreCSS group (45 vs. 11). Conclusion The use of a clinical surveillance system has demonstrated an efficient way to transition outpatient antimicrobial stewardship to a prospective, interventional approach. Disclosures All authors: No reported disclosures.

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91. Development of an Electronic Algorithm to Identify Inappropriate Antibiotic Prescribing for Pediatric Otitis Media

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.401 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S176-S177

Author(s):

Ebbing Lautenbach ◽

Jeffrey Gerber ◽

Robert Grundmeier ◽

Keith W Hamilton ◽

Lauri Hicks ◽

...

Keyword(s):

Electronic Health Record ◽

Otitis Media ◽

Chart Review ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Health Record ◽

Test Characteristics ◽

Academic Practices ◽

Electronic Health ◽

The Impact

Abstract Background Antibiotic stewardship (AS) interventions have primarily focused on acute care settings. The majority of antibiotic use, however, occurs in outpatients. The electronic health record (EHR) might provide an effective and efficient tool for outpatient AS. We aimed to develop and validate an electronic algorithm to identify inappropriate antibiotic use for pediatric outpatients with acute otitis media (AOM). Methods Within the Children’s Hospital of Philadelphia (CHOP) Care Network, we used ICD-10 diagnostic codes to identify patient encounters for AOM at any CHOP practice between 3/15/17 – 3/14/18. Exclusion criteria included underlying immunocompromising condition, comorbidities, and concurrent infections that might influence antibiotic use. We randomly selected 450 eligible subjects (150 each from academic practices, non-academic practices, and urgent care). Inappropriate antibiotic use based on CHOP and professional society guidelines were assessed via chart review and served as the basis for assessment of the electronic algorithm which was constructed using only data in the electronic health record (EHR). Criteria for appropriateness focused on the decision to prescribe, the choice of antibiotic, and duration of therapy. Results Of 450 subjects, median age was 2, 46% were female, and 88% were evaluated by a physician (vs. advanced practice provider). On chart review, the prescribing decision was correct in 438 (97%), of which 25 appropriately received no antibiotics. Of the 413 subjects who were appropriately prescribed an antibiotic, the choice of antibiotic was appropriate in 37 (9%). Finally, of the 413 patients who were appropriately treated, 412 (99.7%) received the correct duration. Test characteristics of the EHR algorithm (compared to chart review) are noted in the Table. Conclusion For children with AOM, an electronic algorithm for identification of inappropriate antibiotic prescribing is highly accurate. This algorithm can also highlight for which elements of prescribing the impact of an intervention might be greatest (i.e., choice of agent). Future work should validate this approach in other health systems and geographic regions and evaluate the impact of an audit and feedback intervention based on this tool. Table. Test Characteristics of Electronic Algorithm for Inappropriate Prescribing, Agent, and Duration Disclosures All Authors: No reported disclosures

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Impact of removing ESBL designation from culture reports on the selection of antibiotics for the treatment of infections associated with ESBL-producing organisms

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.46 ◽

2020 ◽

Vol 41 (5) ◽

pp. 604-607 ◽

Cited By ~ 1

Author(s):

Mark D. Lesher ◽

Cory M. Hale ◽

Dona S. S. Wijetunge ◽

Matt R. England ◽

Debra S. Myers ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Antibiotic Prescribing ◽

The Impact ◽

Inhibitor Combination ◽

Lactamase Inhibitor ◽

Selection Of

AbstractWe characterized the impact of removal of the ESBL designation from microbiology reports on inpatient antibiotic prescribing. Definitive prescribing of carbapenems decreased from 48.4% to 16.1% (P = .01) and β-lactam–β-lactamase inhibitor combination increased from 19.4% to 61.3% (P = .002). Our findings confirm the importance of collaboration between microbiology and antimicrobial stewardship programs.

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152. Applying A Difference-in-Difference Analysis to Assess Effect of Antimicrobial Stewardship Strategies on Changes in Antimicrobial Use

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.197 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S86-S86

Author(s):

Ann F Chou ◽

Yue Zhang ◽

Makoto M Jones ◽

Christopher J Graber ◽

Matthew B Goetz ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Clinical Pharmacist ◽

Antibiotic Use ◽

Feedback Mechanism ◽

Health Care Facilities ◽

Antimicrobial Use ◽

Time Points ◽

The Difference ◽

The Impact ◽

Over Time

Abstract Background About 30–50% of inpatient antimicrobial therapy is sub-optimal. Health care facilities have utilized various antimicrobial stewardship (AS) strategies to optimize appropriate antimicrobial use, improve health outcomes, and promote patient safety. However, little evidence exists to assess relationships between AS strategies and antimicrobial use. This study examined the impact of changes in AS strategies on antimicrobial use over time. Methods This study used data from the Veterans Affairs (VA) Healthcare Analysis & Informatics Group (HAIG) AS survey, administered at 130 VA facilities in 2012 and 2015, and antimicrobial utilization from VA Corporate Data Warehouse. Four AS strategies were examined: having an AS team, feedback mechanism on antimicrobial use, infectious diseases (ID) attending physicians, and clinical pharmacist on wards. Change in AS strategies were computed by taking the difference in the presence of a given strategy in a facility between 2012–2015. The outcome was the difference between antimicrobial use per 1000 patient days in 2012–2013 and 2015–2016. Employing multiple regression analysis, changes in antimicrobial use was estimated as a function of changes in AS strategies, controlling for ID human resources in and organizational complexity. Results Of the 4 strategies, only change in availability of AS teams had an impact on antimicrobial use. Compared to facilities with no AS teams at both time points, antibiotic use decreased by 63.9 uses per 1000 patient days in facilities that did not have a AS team in 2012 but implemented one in 2015 (p=0.0183). Facilities that had an AS team at both time points decreased use by 62.2 per 1000 patient days (p=0.0324). Conclusion The findings showed that AS teams reduced inpatient antibiotic use over time. While changes in having feedback on antimicrobial use and clinical pharmacist on wards showed reduced antimicrobial use between 2012–2015, the differences were not statistically significant. These strategies may already be a part of a comprehensive AS program and employed by AS teams. In further development of stewardship programs within healthcare organizations, the association between AS teams and antibiotic use should inform program design and implementation. Disclosures All Authors: No reported disclosures

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1138. Script for Pediatrics: Creating a Smartphone Application to Improve Antimicrobial Prescribing

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1002 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S405-S405

Author(s):

Sarah Primhak ◽

Natasha Pool ◽

Gayl Humphrey ◽

Lesley Voss ◽

Rachel H Webb ◽

...

Keyword(s):

Decision Making ◽

Antimicrobial Stewardship ◽

Point Of Care ◽

Smartphone Application ◽

Antibiotic Prescribing ◽

Oral Antibiotic ◽

Duration Of Treatment ◽

Antibiotic Allergy ◽

Alternative Agent ◽

The Impact

Abstract Background When considering antimicrobial stewardship (AMS) interventions, pediatrics is an important and often overlooked group. By 5 years of age, 97% of New Zealand (NZ) children have received antibiotics (median 8 antibiotic courses/child). Prescribing is complex due to age and weight-based adjustments, unpalatable oral preparations and inappropriate allergy labeling. Our tertiary Children’s Hospital has >250 web-based nationally utilized guidelines, 15% including antimicrobials. A point prevalence audit showed only 63% guideline adherence for inpatient antimicrobial prescriptions. We designed an accessible app to bring antibiotic prescribing and antibiotic allergy decision-making to prescribers at point of care. Methods Using local hospital and community guidelines, the national formulary and in consultation with subspecialist teams, 31 algorithms were developed. Each algorithm asked questions including diagnosis, age, antibiotic allergy history and known colonization with-resistant organisms. Results The smartphone app (Script) uses the algorithms to advise on appropriate antimicrobial, dose, route and duration of treatment. Advice regarding IV-oral switch parameters and oral antibiotic choice is provided. If allergy is suspected symptom-based decision-making enables the user to choose an alternative agent or encourages allergy de-labeling. Further AMS occurs in some algorithms when advice is given not to prescribe antimicrobials. Conclusion Script for Pediatrics launched in NZ in March 2019 with >1000 users in the first 6 weeks. The most frequently accessed guidelines are otitis media, pneumonia and meningitis. Smartphone applications with local relevance and the ability to update in real-time may prove important tools, by providing easily accessible and intuitive advice to help support antimicrobial stewardship activities. This intervention has been rapidly adopted by pediatric hospital prescribers. The impact on prescribing in concordance with guidelines, timely intravenous to oral antibiotic switch and allergy de-labeling will be assessed. Disclosures All authors: No reported disclosures.

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