977. An Innovative 3-Year Medical Student Spiral Curriculum in Antimicrobial Stewardship and Infectious Diseases

Abstract Background By 2050, infections due antimicrobial-resistant organisms are predicted to account for 10 million deaths/year worldwide. Physician antibiotic prescribing patterns are a significant factor in the development of antibiotic resistance organisms. Early, continual, and integrated medical student education may help students develop a framework for responsible antimicrobial use as they develop prescribing patterns. Methods We designed a spiral antimicrobial stewardship curriculum (defined as revisiting the same concept but with increasing complexity) for medical students in years 2–4. Data provided by the Graduation Questionnaire (GQ) administered by the US Association of American Colleges were used. We compared student responses during the curriculum rollout in 2013–2015 between students at our institution and other schools. We also surveyed graduating seniors in 2015 about antimicrobial stewardship training. Results Using GQ data for the class of 2013 (preintervention), a similar proportion of UCSF medical students compared with other US medical students rated microbiology clinical preparation as excellent (43.6% vs. 45.1%, P > 0.20). For the 2014 class, we developed interactive case-based sessions at the beginning of years 3 and 4. After this first intervention, a higher proportion of UCSF students rated the microbiology clinical preparation as excellent (51.3%) compared with responses at all schools (39.8%, odds ratio [OR] 1.59, 95% confidence interval [CI] 1.1–2.3, P = 0.013). For the class of 2015, we added content during the medicine clerkship and 1 week before graduation. For the 2015 class, an even higher proportion of UCSF students rated microbiology preparation as excellent (57.6%), compared with all schools (41.2%, OR 2.23, 95% CI 1.54–3.22, P < 0.0001). From our survey, 88% were very or extremely satisfied with antimicrobial stewardship training. Conclusion A spiral curriculum focusing on antimicrobial stewardship and infectious diseases increases student perception of clinical preparation prior to graduation. As the curriculum was incrementally introduced, students’ knowledge increased indicating a dose–response pattern. Based on these positive results, we plan to introduce more content throughout UME, and link to curriculum for GME and practicing clinicians. Disclosures All authors: No reported disclosures.

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Diagnostic Stewardship in Lower Respiratory Tract Infections Using Procalcitonin

Antimicrobial Stewardship & Healthcare Epidemiology ◽

10.1017/ash.2021.58 ◽

2021 ◽

Vol 1 (S1) ◽

pp. s31-s32

Author(s):

Amanda Gusovsky ◽

David Burgess ◽

Donna Burgess ◽

Emily Slade ◽

Chris Delcher ◽

...

Keyword(s):

Length Of Stay ◽

Infectious Diseases ◽

Respiratory Tract ◽

Lower Respiratory Tract ◽

Respiratory Tract Infections ◽

Length Of Hospital Stay ◽

Prescribing Patterns ◽

Antibiotic Prescribing ◽

Lower Respiratory Tract Infections ◽

Tract Infections

Background: A team of infectious diseases physicians, infectious diseases pharmacists, clinical laboratorians, and researchers collaborated to assess the management of lower respiratory tract infections (LRTIs). In 1 sample from our institution, 96.1% of pneumonia cases were prescribed antibiotics, compared to 85.0% in a comparison group. A collaborative effort led to the development of a protocol for procalcitonin (PCT)-guided antibiotic prescribing that was approved by several hospital committees, including the Antimicrobial Stewardship Committee and the Healthcare Pharmacy & Therapeutics Committee in December 2020. The aim of this analysis was to develop baseline information on PCT ordering and antibiotic prescribing patterns in LRTIs. Methods: We evaluated all adult inpatients (March–September 2019 and 2020) with a primary diagnosis of LRTI who received at least 1 antibiotic. Two cohorts were established to observe any potential differences in the 2 most recent years prior to adoption of the PCT protocol. Data (eg, demographics, specific diagnosis, length of stay, antimicrobial therapy and duration, PCT labs, etc) were obtained from the UK Center for Clinical and Translational Science, and the study was approved by the local IRB. The primary outcome of interest was antibiotic duration; secondary outcomes of interest were PCT orders, discharge antibiotic prescription, and inpatient length of stay. Results: In total, 432 patients (277 in 2019 and 155 in 2020) were included in this analysis. The average patient age was 61.2 years (SD, ±13.7); 47.7% were female; and 86.1% were white. Most patients were primarily diagnosed with pneumonia (58.8%), followed by COPD with complication (40.5%). In-hospital mortality was 3.5%. The minority of patients had any orders for PCT (29.2%); among them, most had only 1 PCT level measured (84.1%). The median length of hospital stay was 4 days (IQR, 2–6), and the median duration of antibiotic therapy was 4 days (IQR, 3–6). Conclusions: The utilization of PCT in LRTIs occurs in the minority of patient cases at our institution and mostly as a single measurement. The development and implementation of a PCT-guided therapy could help optimize antibiotic usage in patients with LRTIs.Funding: NoDisclosures: None

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1122. Implementation of an Outpatient Antimicrobial Stewardship Program within a Pediatric Health System

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.986 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S398-S399

Author(s):

Alaina Burns ◽

Brian R Lee ◽

Jennifer Goldman ◽

Angela Myers ◽

...

Keyword(s):

Otitis Media ◽

Antimicrobial Stewardship ◽

Safety Net ◽

Baseline Data ◽

Prescribing Patterns ◽

Urgent Care ◽

Antibiotic Prescribing ◽

Targeted Interventions ◽

Core Elements ◽

Tract Infections

Abstract Background Over 60% of antibiotic expenditures occur in outpatient settings with at least 30% being unnecessary. In 2016, the Centers for Disease Control and Prevention (CDC) defined core elements for outpatient antimicrobial stewardship programs (ASP): commitment from all members of the healthcare team, action for policy and practice, tracking and reporting, and education and expertise. Quantifying local prescribing practices and frontline provider engagement are essential for successful outpatient ASP. We describe our outpatient ASP efforts at Children’s Mercy Kansas City (CM) emergency departments (ED) and urgent care clinics (UCC). Methods In March 2018, we created a report defining antibiotic prescribing patterns in 16 common pediatric infections using ICD-10 codes from ED and UCC encounters. Baseline data helped identify areas for targeted interventions and establish ED/UCC engagement, which we have maintained by ongoing review and sharing of data with leadership and frontline providers. Results Baseline data showed low antibiotic prescribing rates (<5%) for most viral infections, except a rate of 74% in otitis media with effusion (OME) (Figure 1). We also identified a higher rate of cefdinir use in acute otitis media (AOM), community-acquired pneumonia, and urinary tract infections (Figure 2). We developed and shared an outpatient antibiotic handbook facilitating diagnosis and treatment of common infections. Ongoing QI teams are focusing on increasing utilization of safety-net antibiotic prescriptions for eligible patients with AOM in EDs, decreasing antibiotic prescriptions of OME, and decreasing unnecessary rapid streptococcal testing in UCCs. Through these multiple interventions, in addition to email communications and newsletter articles, we observed early improvements in prescribing patterns, including OME antibiotic prescriptions and cefdinir use (Figures 1 and 2). Conclusion We used the CDC’s core elements for outpatient ASP to successfully develop interventions in our EDs and UCCs. We created a report defining baseline prescribing patterns and identifying opportunities for improvement. Data sharing with leadership and frontline providers facilitated widespread engagement in ASP efforts. Disclosures All authors: No reported disclosures

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1119. Implementation of Pediatric Antimicrobial Stewardship Rounds in a Children’s Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.983 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S397-S398

Author(s):

Natalie Tucker ◽

Ezzeldin Saleh ◽

Marcela Rodriguez

Keyword(s):

Infectious Diseases ◽

Antimicrobial Stewardship ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Antibiotic Prescribing ◽

Successful Implementation ◽

Custom Made ◽

Days Of Therapy ◽

Before And After ◽

The Individual

Abstract Background Antimicrobial stewardship programs (ASP) are required in all acute care hospitals per The Joint Commission. ASP must adhere to the recommendations laid out by the Centers for Disease Control and Prevention, but how each ASP chooses to implement these recommendations is left to the individual program. In January 2018, we began formal antimicrobial stewardship (AMS) walking rounds, led by infectious diseases trained physician and pharmacist, in our 99-bed pediatric hospital. Methods In January 2018, we started twice-weekly AMS rounds on the pediatric hospitalist service. A custom-made “Antimicrobial Stewardship Patient List” was designed in our electronic medical record (EMR) to generate a list of all patients receiving antibiotics. The ASP team (comprised of an infectious diseases pharmacist and a pediatric infectious diseases physician) reviewed EMR charts to determine antibiotic prescribing appropriateness and design recommended interventions. Any recommendations and teaching points were then discussed with the hospitalist team in person. After piloting the hospitalist service, AMS rounds were extended to include the general surgery patients and finally the intensive care unit. Data on number of charts reviewed, proposed interventions, and acceptance rates were collected throughout the process. Descriptive statistics were used to assess the intervention data. Results In the first year of the program, 427 patient charts were reviewed with 186 identified interventions. In total, 156 (84.3%) of the interventions were accepted and implemented by the primary team. The most common types of interventions were the duration of therapy (29%), antibiotic discontinuation (16.7%), intravenous to oral conversion (11.3%), de-escalation (10.2%), and infectious diseases consult (5.9%). Conclusion Pediatric AMS rounds led to the successful implementation of the majority of recommended interventions. Future goals of the program include calculating days of therapy per 1000 patient-days to assess antibiotic consumption before and after AMS rounds and to expand into other services to further promote appropriate antibiotic use in hospitalized pediatric patients. Disclosures All authors: No reported disclosures.

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Faces of Resistance: Using Real-world Patients and Their Advocates to Teach Medical Students about Antimicrobial Stewardship

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz487 ◽

2019 ◽

Cited By ~ 1

Author(s):

Priya Nori ◽

Kelsie Cowman ◽

Amanda Jezek ◽

Joshua D Nosanchuk ◽

Magdalena Slosar-Cheah ◽

...

Keyword(s):

Medical Students ◽

Infectious Diseases ◽

Disease Control ◽

Antimicrobial Stewardship ◽

Real World ◽

Response Rate ◽

Control And Prevention ◽

Centers For Disease Control ◽

Patient Stories

Abstract We engaged medical students with antimicrobial stewardship (AS) and resistance (AMR) through patient stories and a panel on AMR advocacy with experts from the Centers for Disease Control and Prevention and the Infectious Diseases Society of America. Students were surveyed on their perceptions about AS and AMR (response rate=139/166, 84%).

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The Role of an Antimicrobial Stewardship Team in the Use of Rapid Diagnostic Testing in Acute Care: An Official Position Statement of the Society of Infectious Diseases Pharmacists

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.11 ◽

2018 ◽

Vol 39 (4) ◽

pp. 473-475 ◽

Cited By ~ 4

Author(s):

Brandon Hill ◽

Navaneeth Narayanan ◽

Elizabeth Palavecino ◽

Katherine K. Perez ◽

Sasha Premraj ◽

...

Keyword(s):

Infectious Diseases ◽

Antimicrobial Stewardship ◽

Diagnostic Testing ◽

Position Statement ◽

Antibiotic Prescribing ◽

Official Position ◽

Essential Components ◽

Reduction Strategies ◽

Diagnostic Technologies

Rapid diagnostic technologies can assist Antimicrobial Stewardship Programs (ASPs) in achieving the goals of reducing unnecessary antimicrobial exposure and optimizing patient care. The Society of Infectious Diseases Pharmacists supports all members of the ASP team as essential components of optimal use of these technologies for management of antibiotic prescribing and cost-reduction strategies.Infect Control Hosp Epidemiol 2018;39:473–475

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83. ID Coaches Contribute to a Highly Effective Learning Experience for Third-Year Medical Students Rotating on the Infectious Diseases Consult Service

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.083 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S53-S54

Author(s):

Erin Roberts ◽

Rachel Sigler ◽

Elliott Welford ◽

Jocelyn Keehner ◽

Darcy Wooten

Keyword(s):

Medical Students ◽

Infectious Diseases ◽

Clinical Skills ◽

Clinical Care ◽

General Medicine ◽

Consult Service ◽

Medicine Clerkship ◽

Highly Effective ◽

Early Learners ◽

The Impact

Abstract Background Education on infections in hospitalized patients, antimicrobial selection, and principles of antimicrobial stewardship are foundational to all clinicians. Incorporating early learners into Infectious Diseases (ID) consult services has the potential to build a strong fund of knowledge in these content domains, but also poses potential challenges. We evaluated the impact of a novel clinical rotation and supporting curriculum on third-year medical students rotating on the ID consult service for 2 weeks during their 12-week Internal Medicine clerkship at the University of California, San Diego. Methods Third-year medical students who selected to rotate on the ID consult service were given an hour-long orientation about the service and common infectious syndromes. They were provided with a checklist of clinical skills to complete during the rotation. In addition to daily rounds and clinical care, ID Coaches (ID faculty and senior ID fellows) met with students weekly for 1-2 hours to review ID topics, practice oral presentations, and/or conduct physical exam finding rounds. We surveyed medical students to assess the effectiveness of the rotation. Results Forty third-year medical students participated in the 2-week ID consult rotation between June 2020-May 2021; 31 (77%) completed the rotation evaluation. Seventy percent or more of students reported that the ID rotation facilitated their learning across 8 of 10 ID-content domains (Figure 1). More students reported that the ID Coach facilitated learning (71%) compared to the clinical skills checklist (42%). Students highlighted learning about antimicrobial selection, stewardship, and clinical reasoning on the rotation but reported that teaching was limited when the service census was high (Figure 2). Figure 1: Percent of Students Rating the ID Consult Rotation as Extremely or Very Effective in Facilitating Learning Across 10 Domains Figure 2: Students' Reflections on the Effectiveness of the ID Consult Rotation Conclusion Third-year medical students found that a 2-week rotation on the ID consult service was highly effective in teaching foundational ID content and general medicine skills. Incorporating early learners into a busy and complex subspecialty consult service can be facilitated through the use of supplemental curricular tools such as ID Coaches. Disclosures Darcy Wooten, MD, MS, Nothing to disclose

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Impact of Scribes on Medical Student Education:

Family Medicine ◽

10.22454/fammed.2018.933777 ◽

2018 ◽

Vol 50 (4) ◽

pp. 283-286 ◽

Cited By ~ 3

Author(s):

Julia Hafer ◽

Xibin Wu ◽

Steven Lin

Keyword(s):

Medical Student ◽

Medical Students ◽

Learning Experience ◽

Comparative Method ◽

Medical Student Education ◽

Teaching Quality ◽

Theory Approach ◽

Medicine Clerkship ◽

Student Education ◽

The Impact

Background and Objectives: Medical scribes are an increasingly popular strategy for reducing clerical burden, but little is known about their effect on medical student education. We aimed to evaluate the impact of scribes on medical students’ self-reported learning experience. Methods: We conducted a mixed-methods pilot study. Participants were medical students (third and fourth years) on a family medicine clerkship who worked with an attending physician who practiced with a scribe. Students did not work directly with scribes. Scribes charted for attending physicians during encounters that did not involve a student. Outcomes were three 7-point Likert scale questions about teaching quality and an open-ended written reflection. Qualitative data was analyzed using a constant comparative method and grounded theory approach. Results: A total of 16 medical students returned at least one questionnaire, yielding 28 completed surveys. Students reported high satisfaction with their learning experience and time spent face-to-face with their attending, and found scribes nondisruptive to their learning. Major themes of the open-ended reflections included more time for teaching and feedback, physicians who were less stressed and more attentive, appreciation for a culture of teamwork, and scribes serving as an electronic health records (EHR) resource. Conclusions: To our knowledge, this is the first study evaluating the effect of scribes on medical student education from the students’ perspective. Our findings suggest that scribes may allow for greater teaching focus, contribute to a teamwork culture, and serve as an EHR resource. Scribes appear to benefit medical students’ learning experience. Larger and more rigorous studies are needed.

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2034. Standardized Point Prevalence Survey on Antibiotic Use to Inform Antimicrobial Stewardship Strategies in the Caribbean

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1714 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S683-S684

Author(s):

Jenny Hsieh ◽

Hatim Sati ◽

Pilar Ramon-Pardo ◽

Nienke Bruinsma ◽

Marcelo F. Galas ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Antibiotic Use ◽

Point Prevalence ◽

Prescribing Patterns ◽

Antibiotic Prescribing ◽

Antimicrobial Use ◽

Feedback Systems ◽

Prevalence Survey ◽

Local Capacity ◽

The Caribbean

Abstract Background Inappropriate use of antimicrobials is one of the core contributors to antimicrobial resistance. While hospitals create high selection pressures on bacteria due to the high quantity and broader spectrum of antibiotics used, information on antimicrobial use at the patient level in the Caribbean is sparse. In response, PAHO implemented a standardized WHO methodology to engage national leaderships, build local capacity, and facilitate the use of data to inform antimicrobial stewardship programs (ASP) in the Caribbean. Methods Point prevalence surveys (PPS) were performed in four acute care hospitals in Barbados, Guyana and Saint Lucia between June and July 2018. Medical records of all inpatients were reviewed to collect information on antibiotic use, indications and use of laboratory services (Figure 1). A hospital questionnaire was used to assess hospital infrastructure, policy and practices, and monitoring and feedback systems (Figure 2). Training on PPS methods and electronic data collection tool in REDCap™ were provided to build local capacity and identify potential ASP leaderships. A standardized data validation, analysis and reporting system was built in R to streamline the process. Results and recommendations were disseminated to national authorities and stakeholders to support hospital and national decision-making and training for healthcare providers (Figure 3). Results A total of 60 physicians, nurses, pharmacists, laboratory technicians, and infection control specialists were trained and participated in the PPS. The survey collected records of 816 patients in which 442 (54%) were females and 374 (46%) were males. In total, 356 (44%) patients received 551 antibiotics. Overall, 300 (75%) of 398 indications for antibiotic use were treatment and 72 (18%) were prophylaxis. A higher use of parenteral antibiotics (79%) was observed compared with oral antibiotics (21%). Antibiotic prescribing patterns differed across hospitals. The most commonly used antibiotics were metronidazole (12%) and amoxicillin/clavulanate (11%). Conclusion The PPS method provided a feasible and effective way to collect baseline data and identify target areas for interventions. Engaging national leaderships and building local capacity offered a sustainable way in optimizing antimicrobial use in resource-limited settings. Disclosures All authors: No reported disclosures.

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Copy-and-Paste in Medical Student Notes: Extent, Temporal Trends, and Relationship to Scholastic Performance

Applied Clinical Informatics ◽

10.1055/s-0039-1692402 ◽

2019 ◽

Vol 10 (03) ◽

pp. 479-486 ◽

Cited By ~ 1

Author(s):

Ken Monahan ◽

Cheng Ye ◽

Edward Gould ◽

Meng Xu ◽

Shi Huang ◽

...

Keyword(s):

Medical Student ◽

Medical Students ◽

Student Performance ◽

Temporal Trends ◽

Clinical Knowledge ◽

Medicine Clerkship ◽

Progress Notes ◽

Medical Licensing ◽

Scholastic Performance ◽

Copy And Paste

Background Medical students may observe and subsequently perpetuate redundancy in clinical documentation, but the degree of redundancy in student notes and whether there is an association with scholastic performance are unknown. Objectives This study sought to quantify redundancy, defined generally as the proportion of similar text between two strings, in medical student notes and evaluate the relationship between note redundancy and objective indicators of student performance. Methods Notes generated by medical students rotating through their medicine clerkship during a single academic year at our institution were analyzed. A student–patient interaction (SPI) was defined as a history and physical and at least two contiguous progress notes authored by the same student during a single patient's hospitalization. For some students, SPI pairs were available from early and late in the clerkship. Redundancy between analogous sections of consecutive notes was calculated on a 0 to 100% scale and was derived from edit distance, the number of changes needed to transform one text string into another. Indicators of student performance included United States Medical Licensing Exam (USMLE) scores. Results Ninety-four single SPIs and 58 SPI pairs were analyzed. Redundancy in the assessment/plan section was high (40%) and increased within individual SPIs (to 60%; p < 0.001) and between SPI pairs over the course of the clerkship (by 30–40%; p < 0.001). Students in the lowest tertile of USMLE step II clinical knowledge scores had higher redundancy in the assessment/plan section than their classmates (67 ± 24% vs. 38 ± 22%; p = 0.002). Conclusion During the medicine clerkship, the assessment/plan section of medical student notes became more redundant over a patient's hospital course and as students gained clinical experience. These trends may be indicative of deficiencies in clinical knowledge or reasoning, as evidenced by performance on some standardized evaluations.

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PRESCRIBING PATTERNS OF CEPHALOSPORIN IN CHILDREN FOLLOWING IMPLEMENTATION OF ANTIBIOTIC STEWARDSHIP PROGRAM IN A TERTIARY CARE HOSPITAL AT WESTERN INDI

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2020.v13i9.38403 ◽

2020 ◽

pp. 110-114

Author(s):

ANURADHA JOSHI ◽

URVI KHUMBANI ◽

JAISHREE GANJIWALE ◽

BARNA GANGULY

Keyword(s):

Infectious Diseases ◽

Antibiotic Stewardship ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Prescribing Patterns ◽

Western India ◽

Antibiotic Prescribing ◽

Care Hospital ◽

Stewardship Program ◽

Case Files

Objective: The objective of the study was to study the prescribing patterns of cephalosporins in children following the implementation of Antibiotic Stewardship Program (ASP) in a tertiary care hospital at western India. Methods: This was an observational study of records using data of pre- and post-implementation of ASP. Data were collected from case files of children admitted to pediatric wards in the years 2012 and 2014, respectively. Data were analyzed to find the prescribing pattern of cephalosporin and its appropriateness in relation to ASP program guidelines. Results: Three hundred case files were collected and analyzed (n=150 each from the year 2012 and 2014). The mean age of patients in both years was 6.21 years±5.63 (the year 2012) and 5.88 years±5.88 in (the year 2014). Majority of children, that is, 47.3% were suffering from infectious diseases in the year 2012 while in the year 2014, 38.7% suffered from infectious diseases. Post-implementation of ASP, there was an improvement in the appropriateness of cephalosporin prescribing in terms of prophylactic and empirical treatments. Switch over of parenteral cephalosporins to oral was observed in 54.0% patients in 2012, while in 2014, it was seen in 51.3% of patients. There was a 4.6% rise in prescriptions containing 1st generation cephalosporins. Overall there was a significant impact of ASP in terms of appropriate cephalosporin prescribing (p=0.039). Conclusion: Implementation of ASP and its adherence by pediatricians can improve antibiotic prescribing in children.

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