scholarly journals 180. Leveraging the Electronic Medical Record as a Method of Antibiotic Stewardship

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S97-S97
Author(s):  
Christina M Kaul ◽  
Eric Molina ◽  
Donna Armellino ◽  
Mary Ellen Schilling ◽  
Mark Jarrett
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Antibiotic Usage ◽  
P Value ◽  
Inpatient Setting ◽  
Post Intervention ◽  
Paired Samples ◽  
Viable Method

Abstract Background Overutilization of antibiotics remains an issue in the inpatient setting. What is more, many protocols geared toward curbing improper antibiotic use rely heavily on resource- and personnel-intensive interventions. Thus, the potential for using the EMR to facilitate antibiotic stewardship remains largely unexplored. Methods We implemented a novel change for ordering certain antibiotics in our EMR: ceftriaxone, daptomycin, ertapenem, imipenem, meropenem, and piperacillin-tazobactam. When ordering one of these antibiotics, providers had to note a usage indication, which assigned a usage duration as per our Antibiotic Stewardship Committee guidelines. Pre-intervention, manual discontinuation was required if a provider did not enter a duration. The intervention was enacted August 2019 in 13 hospitals. Data was collected from January 2018 to February 2020. Antibiotic usage was reported monthly as rate per 1000-patient days. Monthly pre- and post-intervention rates were averaged, respectively. Paired samples t-tests were used to compare pre- and post-intervention rates per unit type per hospital. A p-value of less than 0.05 was considered significant. Units with minimal usage, as defined by a pre- or post-intervention mean of 0, were excluded from analysis. Example of Ordering an Antibiotic Prior to Intervention Example of Ordering an Antibiotic After Intervention Results Ertapenem was noted to have a statistically significant decrease in utilization in seven units at three hospitals. Piperacillin-tazobactam was found to have a decrease in utilization in 19 units at eight hospitals. Daptomycin was found to have a decrease in utilization in one unit. Significant decreases in the utilization of ceftriaxone, imipenem, and meropenem were not noted. Example of Statistically Significant Decreased Utilization in Piperacillin-Tazobactam on a Medical-Surglcal Unit Conclusion Our study showed a statistically significant decrease in use of ertapenem, piperacillin-tazobactam and daptomycin using a simple built-in EMR prompt that curtails provider error. This should allow for an increased ease of integration, as the protocol does not require a host of resources for maintenance. Of note is decreased utilization of piperacillin-tazobactam and ertapenem across multiple hospitals, most notably on the medical and surgical wards. Thus, usage of the EMR without personnel-intensive protocols is a viable method for augmenting antibiotic stewardship in health systems. Disclosures All Authors: No reported disclosures

scholarly journals Non-pharmacological motor-cognitive treatment to improve the mental health of elderly adults

2019 ◽  
Vol 65 (3) ◽  
pp. 394-403 ◽  
Author(s):  
Javiera Ponce ◽  
Claudia Latín ◽  
Víctor Leiva ◽  
Guillermo Cortés ◽  
Fernando Rodríguez ◽  
...  
Keyword(s):  
Dual Task ◽  
Low Cost ◽  
Wilcoxon Test ◽  
P Value ◽  
Elderly Adults ◽  
Cognitive Level ◽  
Post Intervention ◽  
Institutionalized Elderly ◽  
Paired Samples ◽  
Parametric Version

SUMMARY OBJECTIVE: To propose a program of physical-cognitive dual task and to measure its impact in Chilean institutionalized elderly adults. METHOD: Experimental design study with pre and post-intervention evaluations, measuring the cognitive and depressive levels by means of the Pfeiffer test and the Yesavage scale, respectively. The program was applied for 12 weeks to adults between 68 and 90 years old. The statistical analysis was based on the nonparametric Wilcoxon test for paired samples and was contrasted with its parametric version. The statistical software R was used. RESULTS: Statistically significant differences were obtained in the cognitive level (p-value < 0.05) and highly significant (p-value < 0.001) in the level of depression with both tests (parametric and nonparametric). CONCLUSION: Due to the almost null evidence of scientific interventions of programs that integrate physical activity and cognitive tasks together in Chilean elderly adults, a program of physical-cognitive dual task was proposed as a non-pharmacological treatment, easy to apply and of low cost to benefit their integral health, which improves significantly the cognitive and depressive levels of institutionalized elderly adults.

scholarly journals The Effect of an Electronic Medical Record Intervention on Hydroxychloroquine Prescribing Habits and Surveyed Providers’ Opinions of the 2016 American Academy of Ophthalmology Guidelines in the Rheumatology and Dermatology Practices of an Academic Institution

2021 ◽  
Author(s):  
Rebecca Overbury ◽  
Jakrapun Pupaibool ◽  
Christopher Hansen ◽  
Dorota Lebiedz-Odrobina
Keyword(s):  
American Academy ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Statistical Significance ◽  
Demographic Data ◽  
Academic Institution ◽  
Controlled Study ◽  
Post Intervention ◽  
Prescribing Habits ◽  
Improve Compliance

Abstract Background Retinal toxicity is a rare adverse event related to the use of hydroxychloroquine (HCQ). To address this, in 2016, the American Academy of Ophthalmology (AAO) issued guidelines recommending that HCQ not exceed 5 mg/kg/day. We analyzed HCQ prescribing habits at our institution, compared to these guidelines, and used surveys to determine the opinions on these guidelines. We then introduced, in a prospective and non-controlled study, an electronic medical record (EMR) tool to study how this intervention might affect compliance with or opinions on these guidelines. Methods Data were collected pre-intervention (June 2017 - January 2019) and post-intervention (March 2019 - April 2020). In January 2019 we released our EMR tool. Results were analyzed using descriptive statistics for demographic data and Fisher’s exact tests for comparisons of proportions between groups. Results Pre-intervention, we reviewed 1,128 rheumatology charts and 282 dermatology charts. 31.0% and 39.7% respectively (32.8% combined) were prescribed HCQ > 5 .0 mg/kg/day. Post-intervention, we reviewed 1,158 rheumatology charts and 106 dermatology charts. 23.1% and 26.4% respectively (23.3% combined) were prescribed HCQ > 5.0 mg/kg/day. Post-intervention, fewer patients (9.5%) were prescribed HCQ > 5 mg/kg/day (p < 0.00001). Pre-intervention, we compiled 18 rheumatology surveys and 12 dermatology surveys. Post-intervention, we compiled 16 rheumatology surveys and 12 dermatology surveys. Post-intervention, fewer rheumatologists incorrectly described the AAO weight-based guidelines. Combined, there was an overall reduction but not of statistical significance (p = 0.47). Conclusions At our academic institution, there remains unfamiliarity of and hesitation to comply with the 2016 AAO guidelines. Prescribed doses often exceed what is recommended in these guidelines. An EMR tool can improve compliance with these guidelines and might improve providers’ familiarity with these guidelines.

scholarly journals 159. Improving Antibiotic Use for Sinusitis and Upper Respiratory Tract Infections: A Virtual Visit Antibiotic Stewardship Initiative

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S96-S96
Author(s):  
Anastasia Wasylyshyn ◽  
Keith S Kaye ◽  
Julia Chen ◽  
Haley Haddad ◽  
Jerod Nagel ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Upper Respiratory Tract Infections ◽  
P Value ◽  
Upper Respiratory Tract ◽  
Post Intervention ◽  
Upper Respiratory ◽  
Tract Infections

Abstract Background Asynchronous virtual patient care is growing in popularity; however, the effectiveness of virtually delivering guideline-concordant care in conjunction with antibiotic stewardship initiatives remains uncertain. We developed a bundled stewardship intervention aimed at improving antibiotic use in E-visits for upper respiratory tract infections (URTIs). Methods In this pre-post study, adult patients who completed an E-visit for “cough,” “flu,” or “sinus symptoms” at Michigan Medicine between 1/1/2018 and 9/30/2020 were included. Patient demographics, diagnoses, and antibiotic details were collected. The multi-faceted intervention occurred over 6 months (Figure 1). We performed segmented linear regression to estimate the effect of the intervention on the level and trend of appropriate antibiotic use for URTI diagnosis (defined as no antibiotic prescribed) and sinusitis (defined as guideline-concordant antibiotic selection and duration). Regression lines were fit to data before (March 2019) and after (May 2019) the physician championing period. Results Among 5151 E-visits, the mean age was 46 years old, and most patients were female (71.3%, N=3674). 3405/5151 E-visits were for URTI. Inappropriate antibiotic use for URTI was stable in trend prior to the audit and feedback intervention (Figure 2), followed by a 12% (P-value = 0.01) decrease in inappropriate antibiotic use post-intervention. The trend in inappropriate antibiotic use continued to decrease after the intervention by 1.1%/month (P-value = 0.02) (Figure 2a). Of 2493/5151 E-visits specifically for sinus symptoms, guideline-concordant antibiotic use was low (intercept = 8%) pre-intervention (Figure 2b). Post-intervention, there was an estimated 47% increase (P-value &lt; 0.001) in patients receiving guideline-concordant antibiotics. Solid line represents time of the webinar, dashed line represents time of modified questionnaire roll out and electronic medical record “nudges”, and shaded area is time of physician champion intervention. Guideline-concordant antibiotic prescribing for sinusitis included amoxicillin/clavulanate or doxycycline prescribed for a duration of 5-7 days Conclusion A multifaceted stewardship bundle for E-visits improved guideline-concordant antibiotic use for URTIs. Changes implemented in the EMR are most beneficial after a period of audit and feedback. This approach can aid stewardship efforts in the ambulatory care setting particularly with regards to telemedicine. Disclosures Tejal N. Gandhi, MD, Blue Cross Blue Shield of Michigan (Individual(s) Involved: Self): Grant/Research Support Lindsay A. Petty, MD, Nothing to disclose

scholarly journals Episodic oral antibiotic use in CF: Discordance between the electronic medical record and self-report

2016 ◽  
Vol 15 (5) ◽  
pp. 630-633 ◽  
Author(s):  
Lindsay J. Caverly ◽  
Tanner J. Caverly ◽  
Linda M. Kalikin ◽  
Bridget K. Foster ◽  
Richard H. Simon ◽  
...  
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Antibiotic Use ◽  
Self Report ◽  
Oral Antibiotic

scholarly journals Use of Procalcitonin and a Respiratory Polymerase Chain Reaction Panel to Reduce Antibiotic Use via an Electronic Medical Record Alert

2019 ◽  
Vol 71 (7) ◽  
pp. 1684-1689 ◽  
Author(s):  
Tony Moradi ◽  
Nicholas Bennett ◽  
Shelby Shemanski ◽  
Kevin Kennedy ◽  
Andrew Schlachter ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Respiratory Tract ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Antibiotic Use ◽  
Chain Reaction ◽  
Days Of Therapy ◽  
Polymerase Chain ◽  
Tract Infections ◽  
Viral Respiratory

Abstract Background Respiratory tract infections are often viral and but are frequently treated with antibiotics, providing a significant opportunity for antibiotic de-escalation in patients. We sought to determine whether an automated electronic medical record best practice alert (BPA) based on procalcitonin and respiratory polymerase chain reaction (PCR) results could help reduce inappropriate antibiotic use in patients with likely viral respiratory illness. Methods This multisite, pre–post, quasi-experimental study included patients 18 years and older with a procalcitonin level &lt;0.25 ng/mL and a virus identified on respiratory PCR within 48 hours of each other, and 1 or more systemic antibiotics ordered. In the study group, a BPA alerted providers of the diagnostic results suggesting viral infection and prompted them to reassess the need for antibiotics. The primary outcome measured was total antibiotic-days of therapy. Results The BPA reduced inpatient antibiotic-days of therapy by a mean of 2.2 days compared with patients who met criteria but did not have the alert fire (8.0 vs 5.8 days, respectively, P &lt; .001). The BPA also reduced the percentage of patients prescribed antibiotics on discharge (20% vs 47.8%, P &lt; .001), whereas there was no difference in need for antibiotic escalation after initial discontinuation (7.6% vs 4.3%, P = .198). Conclusions The automated antimicrobial stewardship BPA effectively reduced antibiotic use and discharge prescribing rates when diagnostics suggested viral respiratory tract infection, without a higher rate for reinitiation of antibiotics after discontinuation.

scholarly journals Comparing prescribing and dispensing databases to study antibiotic use: a validation study of the Electronic Medical Record Administrative data Linked Database (EMRALD)

2019 ◽  
Vol 74 (7) ◽  
pp. 2091-2097 ◽  
Author(s):  
Kevin L Schwartz ◽  
Andrew S Wilton ◽  
Bradley J Langford ◽  
Kevin A Brown ◽  
Nick Daneman ◽  
...  
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Administrative Data ◽  
Validation Study ◽  
Antibiotic Use

Variability in Vancomycin Use in Newborn Intensive Care Units Determined From Data in an Electronic Medical Record

2008 ◽  
Vol 29 (7) ◽  
pp. 667-670 ◽  
Author(s):  
Cody Arnold ◽  
Reese Clark ◽  
Jaclyn Bosco ◽  
Craig Shoemaker ◽  
Alan R. Spitzer
Keyword(s):  
Intensive Care ◽  
Medical Record ◽  
Intensive Care Units ◽  
Electronic Medical Record ◽  
Antibiotic Use ◽  
Medical Record Data ◽  
Electronic Medical Record Data ◽  
Record Data ◽  
Newborn Intensive Care

Data from an electronic medical record were used to demonstrate a large variation in the proportion of patients treated with vancomycin in 56 newborn intensive care units, which ranged from 18% to 70% . Use of oxacillin or nafcillin instead of vancomycin was rare during the first few years of the study period but was routine in 13% of the newborn intensive care units during the last fewyears of the study period. The use of electronic medical record data for studies of antibiotic use is discussed here.

scholarly journals 585. A Cost-Effective Implementation Reducing The Number Of Urine Cultures In An Acute Care Community Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S356-S357
Author(s):  
Rohit Jain ◽  
Nitasa Sahu ◽  
Denise Marsh ◽  
Shannon Raines ◽  
Kirk Jones ◽  
...  
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Urine Analysis ◽  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Common Finding ◽  
Clinical Indication ◽  
Inpatient Setting ◽  
The Impact ◽  
Order Set

Abstract Background Asymptomatic bacteriuria is a common finding in hospitalized patients. This is defined as bacteriuria of ≥105 colony-forming units (cfu) per mL without any genitourinary signs or symptoms. Treatment for such leads to increased antimicrobial resistance and is especially common in the inpatient setting. One study showed a lack of appropriate clinical indication to order a urinalysis in more than half of the patients. In order to expedite a patient’s care, it is common to order a urinalysis and urine culture together and await the results. One study evaluated the impact of changing the order set in inpatients and yielded a 45% reduction in the urine cultures ordered and cost savings as high as $103,845. Reflex testing is used to facilitate effective and efficient patients care while remaining compliant with state and federal regulations in the ordering of lab test. Methods Starting October 25, 2019, the electronic medical record order set was changed so there were only 2 options from the previous 9 options. The modified options included a “Urine analysis with reflex culture” and “Urine analysis with microscopy.” The reflex was not encouraged to be used for those who were pregnant, neutropenic, or had any evidence of immunocompromise. Results Following the implementation of this initiative in October 2019, there was a decrease in overall urine culture cost. From Jan 2019 to September 2019, the cost ranged between $13428.96 to $15157.44/month in the Emergency Department. On the inpatient side, it ranged between $5141.12 to $6559.36/month. After revision of the new order set, the ED cost had dropped to as low as $5672.96/month and $3811.52/month for inpatients. This is a cost reduction of approximately $9484.48 and $2747.84 for the ED and inpatient, respectively.The total number of cultures also reduced from an average of 326/month in the ED to 193/month. The inpatient number of cultures dropped from an average of 130/month to 102/month. Conclusion Modifying the process of urine culture ordering has significantly cut down cost for both the hospital and patient. With clear education and modification of the electronic medical record, such interventions can dramatically improve the unnecessary testing for UTI’s. Disclosures All Authors: No reported disclosures

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