Evaluation of institutional guideline adherence for carbapenem use at a large academic medical center

Abstract Background Urinary tract infections (UTIs) are often misdiagnosed and mismanaged. Disease state stewardship initiatives targeting UTIs may have a significant impact on the overuse of antimicrobials (ABX). The purpose of our study is to evaluate the effectiveness of a UTI focused disease state stewardship intervention. Methods This retrospective study was conducted at a tertiary care academic medical center. Patients > 18 years of age with a collected urinalysis (UA) and receiving ABX for a UTI were included. Retrospective review of UTI management from 9–11/2017 was performed and used as the baseline. In the post-intervention period, 9–11/2018, the UTI management guideline had been published and service lines educated. A prospective audit and feedback (PAAF) initiative was started 6/2019, whereby the antimicrobial stewardship team performed daily reviews of patients on ABX for UTIs. Patients reviewed 9–11/2019 were included in the PAAF cohort. Exclusion criteria included: pregnancy, undergoing a urologic procedure, treatment of a concomitant infection, receiving therapy based on outside recommendations, or left AMA/expired during treatment. The primary outcome of this study was to evaluate overall guideline adherence. Results 600 patients (200 in each group) were included, with 419 (69.8%) female and an overall median age of 61.4 years. Altered mental status (24.8%) and dysuria (21.5%) were the two main diagnostic testing indications. Treatment of asymptomatic presentations decreased between the three periods, 74.0% vs 48.5% vs 36.0%. Appropriate ordering of UA (33.5% vs 55.0% vs 68.5%, p< 0.001) and urine cultures (29.0% vs 57.1% vs 64.8%, p< 0.001) improved following guideline implementation and PAAF. Interventions by the stewardship team were made in 21% of patients during PAAF, namely therapy discontinuation (78.6%). Overall guideline adherence significantly improved over time, 13.0% vs 27.0% vs 36.5%, p< 0.001. Conclusion UTI disease state intervention was associated with a reduction in the treatment of asymptomatic presentations, increase in appropriate diagnostic ordering, and improvement in overall guideline adherence. PAAF can be a powerful stewardship strategy for promoting consistency in UTI treatment and decreasing unnecessary ABX use. Disclosures All Authors: No reported disclosures

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Evaluation of a Disease State Stewardship Intervention for Urinary Tract Infections at an Academic Medical Center

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.771 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s226-s226

Author(s):

Xhilda Xhemali ◽

Derek Forster ◽

Bryant Clemons ◽

Sarah Cotner ◽

Jeremy VanHoose ◽

...

Keyword(s):

Urinary Tract ◽

Real Time ◽

Urinary Tract Infections ◽

Guideline Adherence ◽

Medical Center ◽

Academic Medical Center ◽

Disease State ◽

Academic Medical ◽

Before And After ◽

Tract Infections

Background: Urinary tract infections (UTIs) are often misdiagnosed and mismanaged. Disease state stewardship initiatives targeting UTIs through the development of institutional guidelines and real-time prospective audit and feedback (PAAF) on provider management may have a significant impact on the overuse of antimicrobials. Objective: Our study evaluated the effectiveness of a UTI focused disease state stewardship intervention by assessing institutional guideline adherence before and after implementation. Methods: This retrospective quasi-experimental study was conducted at a tertiary-care academic medical center. Patients >18 years of age receiving antimicrobials for a UTI were included. A previously performed retrospective review of UTI management from September-November 2017 was used as the baseline. The UTI management guideline was implemented in July 2018, and service lines were educated. A PAAF initiative began in June 2019, whereby the antimicrobial stewardship team performed daily reviews of patients receiving antimicrobials for UTIs. Data was collected on their management, and providers were contacted in real time with recommendations based on the institutional guideline. Patients reviewed June–October 2019 were included in the postimplementation analysis. Patients were excluded if they were pregnant, underwent a urological procedure with risk of mucosal bleeding, or were an outside hospital transfer already on UTI therapy. The primary outcome of this study was to evaluate guideline adherence before and after the implementation of PAAF for the management of UTIs. Results: In total, 198 patients in the preintervention group and 246 in the PAAF group were included. The emergency department was the primary ordering service of urinalyses (60.1% vs 66.1%; P = .2287) in both periods and altered mental status as the main indication for testing (35.2% vs 31.3%; P = .5465). Treatment of asymptomatic bacteriuria and pyuria decreased significantly between the 2 periods: 74.8% versus 36.2% (P = .0001). Appropriate ordering of urinalyses (33.8% vs 68.3%; P = .0001) and urine cultures (29.3% vs 61.0%; P = .0001) also improved in the PAAF group. Recommendations made during PAAF included therapy discontinuation (66.7%), antimicrobial therapy change (15.5%), or duration modification (15.5%), and 59.5% of first interventions were accepted. Overall guideline compliance significantly improved from 13.1% in the preintervention period to 26.1% in the PAAF period (P = .0011). Conclusions: A UTI disease state intervention was associated with significant reductions in the treatment of asymptomatic presentations as well as an improvement in overall guideline adherence. We believe that this approach represents a powerful stewardship strategy for decreasing unnecessary antimicrobial usage.Funding: NoneDisclosures: None

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APPLICATION OF THE VERY HIGH RISK CRITERION AND EVALUATION OF CHOLESTEROL GUIDELINE ADHERENCE IN POST-AMI PATIENTS AT AN URBAN ACADEMIC MEDICAL CENTER

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(20)32509-2 ◽

2020 ◽

Vol 75 (11) ◽

pp. 1882

Author(s):

Robert Derenbecker ◽

Erin M. Spaulding ◽

Francoise Marvel ◽

Seth Shay Martin

Keyword(s):

High Risk ◽

Guideline Adherence ◽

Medical Center ◽

Academic Medical Center ◽

Academic Medical ◽

Risk Criterion ◽

Very High

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S0196 The Costs of Guideline Adherence: A Retrospective Evaluation of the Economic Impact of Snare vs Forceps Removal of Diminutive Colon Polyps in an Academic Medical Center

The American Journal of Gastroenterology ◽

10.14309/01.ajg.0000702832.67271.7f ◽

2020 ◽

Vol 115 (1) ◽

pp. S68-S68

Author(s):

Mohamed Azab ◽

Kelli Kam ◽

Emily Lin ◽

Jonathan Pham ◽

Nathan Oh ◽

...

Keyword(s):

Economic Impact ◽

Guideline Adherence ◽

Medical Center ◽

Academic Medical Center ◽

Colon Polyps ◽

Retrospective Evaluation ◽

Academic Medical

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Intravenous levothyroxine stewardship program at a tertiary academic medical center

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxab155 ◽

2021 ◽

Author(s):

Kaylee K Marino ◽

Kaitlin E Crowley ◽

Lena K Tran ◽

Daniel Sylvia ◽

Heather Dell’Orfano ◽

...

Keyword(s):

Guideline Adherence ◽

Medical Center ◽

Guideline Implementation ◽

Academic Medical Center ◽

Cost Savings ◽

Pharmacokinetic Profile ◽

High Rate ◽

Stewardship Program ◽

Academic Medical ◽

The Impact

Abstract Purpose Based on the pharmacokinetic profile of levothyroxine, a 3-day hold guideline for adult patients ordered for intravenous (IV) levothyroxine was implemented at a tertiary academic medical center. The purpose of this study was to evaluate the impact of the implementation of an IV levothyroxine hold guideline. Methods This single-center, retrospective analysis identified patients ordered for IV levothyroxine during a 13-week period before and after implementation of the guideline. The primary outcome was guideline adherence, defined as full implementation of the 3-day hold. Secondary outcomes included the number of IV levothyroxine administrations avoided in the post-guideline group, extrapolated yearly cost avoidance (EYCA) after guideline implementation, reasons for guideline non-adherence, and number of safety reports involving IV levothyroxine. Results A total of 166 and 134 patients met inclusion criteria for the pre- and post-guideline groups, respectively. Guideline adherence was observed in 94 (70.1%) patients, resulting in 276 vials saved in the 13-week post-guideline period, which translated to an EYCA of $139,877. Forty orders (29.9%) were non-adherent to the guideline, with the most common reason stated as nil per os (NPO). No difference in safety outcomes was seen between the pre- and post-guideline groups, as evidenced by 1 safety report in each group. Conclusion We observed a high rate of adherence to an IV levothyroxine hold guideline. This was associated with a substantial cost savings over the study period with no increase in reported safety events. To our knowledge, this is the first published report of an inpatient IV levothyroxine 3-day hold guideline.

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