scholarly journals 1305. Application of Standard Antibiotic Use Criteria to Evaluate Inpatient Antibiotic Use

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S399-S399
Author(s):  
Maureen Campion ◽  
Emily Dionne ◽  
Elizabeth Radigan ◽  
Gail Scully ◽  
Moamen Al Zoubi ◽  
...  
Keyword(s):  
Antimicrobial Agents ◽  
Average Length ◽  
Medical Center ◽  
Pharmacy Practice ◽  
Antibiotic Use ◽  
Antifungal Prophylaxis ◽  
Prescribing Practices ◽  
Icu Patients ◽  
Inappropriate Use ◽  
Days Of Therapy

Abstract Background It is estimated that 30–50% of antimicrobial agents prescribed inpatient are not optimal. Historically, antimicrobial evaluation has been based primarily upon expert opinion of ID trained individuals. Spivak and colleagues proposed standard terminology and definitions to assess antimicrobial prescribing practices. At UMass Memorial Medical Center we utilized Spivak’s criteria to measure antimicrobial use within point prevalence studies (PPS) and assessed the ability of Spivak’s criteria to provide consistent results between different evaluators. Methods A PPS was conducted in September 2017 (SEPT) by infectious disease (ID) attendings and ID trained pharmacists. A follow-up PPS was completed in November 2017 (NOV) by a pharmacy practice resident (PGY-1) and first year ID fellow. Patients were included if they were prescribed antibiotics at the time of review, greater than 18 years of age, and admitted to an inpatient unit. Patients only receiving antiretroviral therapy or antifungal prophylaxis were excluded from the study. Antibiotics, indications, days of therapy, and appropriateness or reason for inappropriateness, as defined by Spivak’s criteria, were collected. Results Four hundred five patients in SEPT and 475 patients in NOV were reviewed. Baseline characteristics between SEPT and NOV, including sex, age, average length of hospital stay (LOS) at time of review were similar between groups, (SEPT vs. NOV: male sex: 53.2% vs. 51.1%; age: 60.4 vs. 61.7; LOS:8.55 vs. 8.36 days). Number of antibiotics per patient was different between PPS (SEPT 1.69 vs. NOV 1.28). For non-intensive care unit (ICU) patients, 64.9% of use was considered appropriate in SEPT vs. 69.3% in NOV. The top reasons for inappropriate use in non-ICU patients in both PPS were no indication and excess length of therapy. Within the ICU, 89.4% of use was considered appropriate in SEPT, with 75% of use considered appropriate in NOV. The top reason for inappropriate use in ICU patients in both PPS was overly broad therapy. Conclusion Application of standard antibiotic evaluation criteria can assist healthcare professionals with different levels of ID training to assess antibiotic use in non-ICU patients. Further evaluation should be considered for critically ill patients. Disclosures All authors: No reported disclosures.

An Interventional Program to Improve Antibiotic Use

2003 ◽  
Vol 37 (5) ◽  
pp. 646-651 ◽  
Author(s):  
Cynthia L Feucht ◽  
Louis B Rice
Keyword(s):  
Clinical Pharmacist ◽  
Antimicrobial Agents ◽  
Medical Center ◽  
Antibiotic Use ◽  
Resistant Bacteria ◽  
Prescribing Practices ◽  
Gram Negative ◽  
Inappropriate Use ◽  
Multidisciplinary Program ◽  
Empiric Antibiotic

BACKGROUND: Large volume and often inappropriate use of specific antimicrobial agents increase selective pressure for emergence of resistant bacteria and place strain on the pharmacy budget. OBJECTIVE: To initiate a multidisciplinary program designed to align intravenous vancomycin and fluoroquinolone prescribing practices with guidelines for appropriate use of these agents. METHODS: A multidisciplinary, prospective interventional program was implemented to encourage early discontinuation of inappropriate vancomycin and fluoroquinolone therapy and decrease inappropriate duplicative gram-negative coverage using fluoroquinolones. A computerized review was performed for patients receiving intravenous vancomycin and fluoroquinolones for 1998 in a Veterans Affairs Medical Center. In June 1999, guidelines were disseminated and an interventional program was initiated, with a monthly conference for medical residents regarding antimicrobial resistance and local hospital practices. Concurrently, a prospective review of new orders was assessed by the clinical pharmacist and interventions performed when inappropriate use occurred. RESULTS: The interventional program was successful in reducing unnecessary duplicative gram-negative coverage with intravenous fluoroquinolones by 26% (p < 0.001) from 1998 to 2001. Overall, a 43% reduction in the number of courses of intravenous fluoroquinolones was seen during these 4 years. Courses lasting >5 days were reduced by 22% (p < 0.001). Vancomycin prescriptions deemed inappropriate that were administered >5 days were reduced by 16% (p < 0.001) during the same time period. The interventions performed by the clinical pharmacist were deemed successful, with a 76% acceptance rate by providers. CONCLUSIONS: Education of physicians through monthly conferences and personal interventions resulted in an increase in appropriate empiric antibiotic use, a decrease in the duration of inappropriate use, and a decrease in duplicate gram-negative coverage.

scholarly journals 154. Antibiotic Use During Three Separate Waves of the COVID-19 Pandemic at a Large Academic Medical Center in Detroit, MI

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S188-S189
Author(s):  
Deepika Sivakumar ◽  
Shelbye R Herbin ◽  
Raymond Yost ◽  
Marco R Scipione
Keyword(s):  
Retrospective Review ◽  
Bacterial Pneumonia ◽  
Medical Center ◽  
Academic Medical Center ◽  
Antibiotic Use ◽  
Percent Change ◽  
Academic Medical ◽  
Days Of Therapy ◽  
Time Periods ◽  
The Impact

Abstract Background Inpatient antibiotic use early on in the COVID-19 pandemic may have increased due to the inability to distinguish between bacterial and COVID-19 pneumonia. The purpose of this study was to determine the impact of COVID-19 on antimicrobial usage during three separate waves of the COVID-19 pandemic. Methods We conducted a retrospective review of patients admitted to Detroit Medical Center between 3/10/19 to 4/24/21. Median days of therapy per 1000 adjusted patient days (DOT/1000 pt days) was evaluated for all administered antibiotics included in our pneumonia guidelines during 4 separate time periods: pre-COVID (3/3/19-4/27/19); 1st wave (3/8/20-5/2/20); 2nd wave (12/6/21-1/30/21); and 3rd wave (3/7/21-4/24/21). Antibiotics included in our pneumonia guidelines include: amoxicillin, azithromycin, aztreonam, ceftriaxone, cefepime, ciprofloxacin, doxycycline, linezolid, meropenem, moxifloxacin, piperacillin-tazobactam, tobramycin, and vancomycin. The percent change in antibiotic use between the separate time periods was also evaluated. Results An increase in antibiotics was seen during the 1st wave compared to the pre-COVID period (2639 [IQR 2339-3439] DOT/1000 pt days vs. 2432 [IQR 2291-2499] DOT/1000 pt days, p=0.08). This corresponded to an increase of 8.5% during the 1st wave. This increase did not persist during the 2nd and 3rd waves of the pandemic, and the use decreased by 8% and 16%, respectively, compared to the pre-COVID period. There was an increased use of ceftriaxone (+6.5%, p=0.23), doxycycline (+46%, p=0.13), linezolid (+61%, p=0.014), cefepime (+50%, p=0.001), and meropenem (+29%, p=0.25) during the 1st wave compared to the pre-COVID period. Linezolid (+39%, p=0.013), cefepime (+47%, p=0.08) and tobramycin (+47%, p=0.05) use remained high during the 3rd wave compared to the pre-COVID period, but the use was lower when compared to the 1st and 2nd waves. Figure 1. Antibiotic Use 01/2019 to 04/2019 Conclusion Antibiotics used to treat bacterial pneumonia during the 1st wave of the pandemic increased and there was a shift to broader spectrum agents during that period. The increased use was not sustained during the 2nd and 3rd waves of the pandemic, possibly due to the increased awareness of the differences between patients who present with COVID-19 pneumonia and bacterial pneumonia. Disclosures All Authors: No reported disclosures

scholarly journals A PROSPECTIVE STUDY ON ANTIMICROBIAL UTILIZATION PATTERN IN OUTPATIENT DEPARTMENT AT TERTIARY CARE HOSPITAL, PUNE, INDIA.

2018 ◽  
Vol 11 (5) ◽  
pp. 131
Author(s):  
Sarang A Deshmukh ◽  
Yashasvi Agarwal ◽  
Harshita Hiran ◽  
Uma Bhosale
Keyword(s):  
Antimicrobial Agents ◽  
Demographic Data ◽  
Tertiary Care ◽  
Essential Medicine ◽  
Antibiotic Use ◽  
Oral Dosage ◽  
Fixed Dose ◽  
Care Hospital ◽  
Prescribing Practices ◽  
Cross Sectional

 Objective: The objective of the study was to evaluate antimicrobial prescription pattern in outpatient departments.Method: This was a prospective, cross-sectional and observational study over 12 weeks total 400 prescriptions of either gender and age; containing antimicrobial agents (AMAs) were analyzed for demographic data and the WHO prescribing indicators.Results: Most of prescription were given to men (n=262). The most common group of AMA used was Cephalosporins (n=141, 35.25%); of which Ceftriaxone was most commonly prescribed (n=73, 18.25%). 10 AMAs were from the WHO essential medicine list AMAs. Men outnumbered women in prescribing antibiotics (n=262 vs. 138). Most of AMAs receivers were between 26 and 35 years (n=128, 32%). Amoxicillin+Clavulanic acid fixed-dose combination was most common (n=84, 21%). Most of the prescriptions were containing four drugs per prescriptions (n=130, 32.5%). Only 10% of the prescription was given by generic name and rest 90% were given by brand name. Oral dosage form of AMAs was predominant (n=340, 85%). Vitamins and supplement were most common comedication received by patients.Conclusion: Antibiotic use was found to be reasonable and rational in most of the cases. However, still, prescribers should improve prescribing practices and make it more rational.

scholarly journals 1116. Impact of Antimicrobial Stewardship Incentive Goals for Pharmacists on Overall Antibiotic Use and Appropriate Duration of Therapy in Urinary Tract Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S397-S397
Author(s):  
Matthew A Miller ◽  
Mattie Huffman ◽  
Nichole Neville ◽  
Misha Huang ◽  
Gerard Barber
Keyword(s):  
Urinary Tract ◽  
Antimicrobial Stewardship ◽  
Group Performance ◽  
Respiratory Infections ◽  
Medical Center ◽  
Academic Medical Center ◽  
Antibiotic Use ◽  
Days Of Therapy ◽  
Essential Resource ◽  
Tract Infections

Abstract Background Urinary tract (UTI), skin and soft tissue, and respiratory infections are among the most frequently reported indications for antibiotics, such that focusing stewardship efforts here would expectedly have dramatic effects. Antimicrobial stewardship (AMS) programs vary in structure and available resources. At the University of Colorado Hospital, a 740-bed academic medical center, dedicated resources for AMS are limited to a pharmacist, pharmacy resident, and physician; however, there is a large clinical pharmacist group. For the past 2 years, pharmacy management incorporated AMS targets as group goals tied to performance bonuses. Methods This is a descriptive report utilizing incentives to achieve AMS goals. The first goal (July 1, 2016 to June 30, 2017) set out to reduce inpatient antibiotic use by 10%. The second goal (July 1, 2018 to June 30, 2018) was a 10% reduction in median antibiotic duration for UTIs. The AMS team provided guidelines, education, and oversight throughout target periods. Antibiotic use was calculated as days of therapy (DOT) per 1000 patient-days. Data related to UTI treatment was collected retrospectively on a quarterly basis. This was compared with baseline data previously collected during a statewide hospital stewardship collaborative project. Results During the first period, overall antibiotic use declined from 497 to 403 DOT per 1000 patient-days (18.9%), and broad-spectrum antibiotic use declined 22%. During the second period, 30 patient charts were reviewed quarterly, and the median UTI duration declined from 10 to 7 days (P = 0.002). The most common UTI diagnoses were similar between periods with complicated cystitis and pyelonephritis comprising 60–70% of cases. The 30-day readmission rate was not different between the baseline and goal period, 11% vs. 6% respectively (P = 0.18). Conclusion The use of group pharmacist goals tied to annual performance bonuses was effective in achieving AMS goals at our institution. In larger facilities with fewer dedicated AMS personnel, clinical pharmacists covering ward and intensive care units are an essential resource to achieving AMS goals. Group performance incentives may be a feasible strategy to generate interest and motivation to achieve AMS program goals. Disclosures All authors: No reported disclosures.

scholarly journals 1034. Automating Assessments of Vancomycin Appropriateness

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S364-S364
Author(s):  
Haley K Holmer ◽  
Caitlin M McCracken ◽  
Gregory B Tallman ◽  
Sara J Gore ◽  
Timothy Shan ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Empiric Therapy ◽  
Automated Classification ◽  
Electronic Health Record Data ◽  
Inappropriate Use ◽  
Days Of Therapy ◽  
Hospital Patients ◽  
Icd 10 ◽  
Procedure Codes

Abstract Background Assessing appropriateness of hospital antibiotic use is typically a labor-intensive task for antimicrobial stewardship teams and relies heavily on clinician judgement rather than a systematic process. Vancomycin is a frequently used agent that is a common stewardship target. We developed an algorithm to automatically classify the appropriateness of vancomycin days of therapy (DOTs) based upon electronic health record data. Methods We constructed a retrospective cohort of Oregon Health and Science University (OHSU) Hospital and Doernbecher Children’s Hospital patients admitted August 1, 2017 to July 31, 2018 receiving vancomycin. Data were collected on demographic, encounter, pharmacy, microbiology, and surgery data. An electronic algorithm was applied to classify vancomycin DOTs as appropriate, inappropriate, or indeterminate. Inappropriate use was defined as any case in which there was an opportunity for de-escalation as identified using microbiology data, ICD-10 codes, and procedure codes. Results We included 4,231 encounters; 493 (12%) were pediatric patients. Our algorithm automatically classified 59%, 3%, and 38% of encounters as having either appropriate, inappropriate, or indeterminate DOTs, respectively. Forty-four percent of all encounters received no more than a 24-hour course of vancomycin and were considered appropriate empiric therapy; half of these were attributed to surgical prophylaxis. Nine percent of all encounters had vancomycin administered within 3 days of a blood, sputum or tissue culture in which either a methicillin-resistant Staphylococcus species or an ampicillin-resistant, vancomycin-susceptible Enterococcus species was isolated and were classified as appropriate. Six percent of all encounters had cultures in which only Gram-negatives, fungi, or yeast were isolated and were therefore considered appropriate in the empiric period (≤48 hours) but inappropriate thereafter. Conclusion Automated assessments of antibiotic appropriateness could facilitate more informed antimicrobial stewardship initiatives and serve as a valuable stewardship metric. Characterization of indeterminate vancomycin use may inform increased automated classification. Further effort is needed to validate these assessments. Disclosures All authors: No reported disclosures.

scholarly journals Inpatient antibiotic utilization in the Veterans’ Health Administration during the coronavirus disease 2019 (COVID-19) pandemic

2020 ◽  
pp. 1-3 ◽  
Author(s):  
Thomas D. Dieringer ◽  
Daisuke Furukawa ◽  
Christopher J. Graber ◽  
Vanessa W. Stevens ◽  
Makoto M. Jones ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Veterans Health Administration ◽  
Antibiotic Prescribing ◽  
Veterans Health ◽  
Health Administration ◽  
Prescribing Practices ◽  
Antibiotic Utilization ◽  
Days Of Therapy

Abstract Antibiotic prescribing practices across the Veterans’ Health Administration (VA) experienced significant shifts during the coronavirus disease 2019 (COVID-19) pandemic. From 2015 to 2019, antibiotic use between January and May decreased from 638 to 602 days of therapy (DOT) per 1,000 days present (DP), while the corresponding months in 2020 saw antibiotic utilization rise to 628 DOT per 1,000 DP.

scholarly journals 327. Assessment of Bacterial Co-infection Rates and Antibiotic Exposure in COVID-19 Patients

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S269-S269
Author(s):  
Adam J Luetkemeyer ◽  
Nick Bennett ◽  
Laura Aragon ◽  
Jeannette Ploetz ◽  
Sarah E Boyd
Keyword(s):  
Health System ◽  
Medical Center ◽  
Academic Medical Center ◽  
Antibiotic Use ◽  
Antibiotic Exposure ◽  
Infection Rates ◽  
Targeted Interventions ◽  
Days Of Therapy ◽  
Secondary Outcomes ◽  
Length Of Therapy

Abstract Background COVID-19 pandemic data suggest risk for bacterial co-infection upon hospital presentation remain extremely low. Despite low co-infection rates, antibiotics are prescribed for most patients. Current data are limited regarding institutional-specific change in antibiotic use over the course of the pandemic. Given the low rates of co-infections, Saint Luke’s Health System’s COVID-19 Treatment Taskforce developed a COVID-19 evaluation and treatment order set which included procalcitonin (PCT) . As co-infection literature emerged, active education was provided, and order sets were modified to provide passive education regarding co-infection rates. We aimed to assess antibiotic practice changes as data and strategies to influence use evolved during the pandemic. Methods This was a multi-center, single health-system retrospective cohort study. Ten community hospitals and 1 academic medical center were included in analysis. Inclusion criteria were age ≥18 years, admitted during April or September 2020 and had a positive COVID-19 result on admission. Patients were excluded if they were readmitted for COVID-19 related issues. Both primary and secondary outcomes were analyzed from the first 7 days after admission. The primary outcome was rate of respiratory bacterial co-infections. This was determined through sputum and blood cultures, urinary antigens including Streptococcus pneumoniae and Legionella, and PCT. Secondary outcomes included rate of antibiotic use, antibiotic days of therapy (DOT), length of therapy, and antibiotic use trends. Baseline Characteristics Results A total of 294 patients were included with 69 patients in April 2020 and 225 in September 2020. Primary and secondary results are shown in Table 2. Rate of culture-confirmed bacterial co-infection when examining April 2020 was 4.38% and 4.44 % in September 2020. Antibiotic uses, antibiotic DOT, and length of therapy were all significantly lower in September 2020 compared to April 2020. Conclusion Our results show bacterial co-infections were extremely low in our health system. Despite positive trends in antibiotic use, prescribing remained high. More targeted interventions to decrease antibiotic exposure in COVID-19 patients are needed. Disclosures All Authors: No reported disclosures

scholarly journals Emergence of Antibiotic Resistance during Therapy for Infections Caused by Enterobacteriaceae Producing AmpC β-Lactamase: Implications for Antibiotic Use

2007 ◽  
Vol 52 (3) ◽  
pp. 995-1000 ◽  
Author(s):  
Sang-Ho Choi ◽  
Jung Eun Lee ◽  
Su Jin Park ◽  
Seong-Ho Choi ◽  
Sang-Oh Lee ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Medical Center ◽  
Antibiotic Use ◽  
Significance Level ◽  
Risk Of Mortality ◽  
Asan Medical ◽  
Bile Duct Invasion ◽  
Emergence Of Resistance

ABSTRACT Enterobacter spp., Serratia marcescens, Citrobacter freundii, and Morganella morganii are characterized by chromosomally encoded AmpC β-lactamases and possess the ability to develop resistance upon exposure to broad-spectrum cephalosporins. To determine the incidences of the emergence of resistance during antimicrobial therapy for infections caused by these organisms and the effect of the emergence of resistance on patient outcomes, all patients who were admitted to the Asan Medical Center (Seoul, Republic of Korea) from January 2005 to June 2006 and whose clinical specimens yielded Enterobacter spp., S. marcescens, C. freundii, or M. morganii were monitored prospectively. The main end point was the emergence of resistance during antimicrobial therapy. A total of 732 patients with infections were included for analysis. The overall incidence of the emergence of antimicrobial resistance during antimicrobial therapy was 1.9% (14/732). Resistance to broad-spectrum cephalosporins, cefepime, extended-spectrum penicillin, carbapenem, fluoroquinolones, and aminoglycosides emerged during treatment in 5.0% (11/218), 0% (0/20), 2.0% (2/100), 0% (0/226), 0% (0/153), and 1.1% (1/89) of patients, respectively. The emergence of resistance to broad-spectrum cephalosporins occurred more often in Enterobacter spp. (8.3%, 10/121) than in C. freundii (2.6%, 1/39), S. marcescens (0%, 0/37), or M. morganii (0%, 0/21). Biliary tract infection associated with malignant bile duct invasion was significantly associated with the emergence of resistance to broad-spectrum cephalosporins (P = 0.024 at a significance level of 0.042, by use of the Bonferroni correction). Only 1 of the 14 patients whose isolates developed resistance during antimicrobial therapy died. The emergence of resistance was more frequently associated with broad-spectrum cephalosporins than with the other antimicrobial agents tested, especially in Enterobacter spp. However, the emergence of resistance was associated with a low risk of mortality.

Changes in the Incidences of Multidrug-Resistant and Extensively Drug-Resistant Organisms Isolated in a Military Medical Center

2010 ◽  
Vol 31 (7) ◽  
pp. 728-732 ◽  
Author(s):  
Edward F. Keen ◽  
Clinton K. Murray ◽  
Brian J. Robinson ◽  
Duane R. Hospenthal ◽  
Edgie-Mark A. Co ◽  
...  
Keyword(s):  
Antimicrobial Agents ◽  
San Antonio ◽  
Medical Center ◽  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Military Healthcare ◽  
Level I ◽  
Combat Casualties ◽  
The Military ◽  
Over Time

Background.Multidrug-resistant (MDR) Acinetobacter baumannii and Pseudomonas aeruginosa have emerged as the causes of nosocomial infections in critically ill patients.Objective.To characterize the incidence of these MDR bacteria over time in the military healthcare system, comparing isolates recovered from overseas combat casualties with isolates recovered from local military and civilian patients.Methods.Retrospective electronic records review of culture and/or susceptibility testing results of patients admitted to a military level I trauma center in San Antonio, Texas, during the period from January 2001 through December 2008. Multidrug resistance was defined as the first isolated organism resistant to 3 or more classes of antimicrobial agents.Results.Over time, the percentage of MDR A. baumannii isolates increased from 4% to 55%, whereas the percentage of MDR P. aeruginosa isolates increased from 2% to 8%. Respiratory tract specimens had a higher percentage of MDR A. baumannii isolates (49%), compared with specimens obtained from blood (30%), wound sites (24%), or urine (19%). No difference in the percentages of MDR P. aeruginosa isolates was observed with regard to source of specimen. The percentage of MDR A. baumannii isolates recovered was higher among patients who had been deployed overseas (52%) than among local patients (20%). When isolates recovered from patients in the burn intensive care unit (53% of MDR A. baumannii isolates) were removed from analysis, the percentage of MDR A. baumannii isolates decreased from 38% to 30% while the percentage of MDR P. aeruginosa isolates remained unaffected.Conclusion.The percentage of MDR A. baumannii isolates increased in this facility among combat casualties and among local patients, which indicates nosocomial transmission; however, there was no significant increase in the percentage of MDR P. aeruginosa isolates. Isolated changes in the MDR pathogens within a facility can occur. Possible interventions to limit the spread of these organisms could include implementing aggressive infection control practices, controlling antibiotic use, and using active culture surveillance.

scholarly journals Potentially Inappropriate Use of Intravenous Opioids in Hospitalized Patients

2019 ◽  
Vol 14 (11) ◽  
pp. 678-680
Author(s):  
Amber B Moore ◽  
Scott Navarrett ◽  
Shoshana J Herzig
Keyword(s):  
Medical Center ◽  
Hospital Medicine ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Gastrointestinal Dysfunction ◽  
Comfort Care ◽  
Inappropriate Use ◽  
Patients With Cancer ◽  
Appropriate Prescribing

Physicians have the potential to decrease opioid misuse through appropriate prescribing practices. We examined the frequency of potentially inappropriate intravenous (IV) opioid use (where oral use would have been more appropriate) in patients hospitalized at a tertiary medical center. We excluded patients with cancer, patients receiving comfort care, and patients with gastrointestinal dysfunction. On the basis of recent guidance from the Society of Hospital Medicine, we defined IV doses as potentially inappropriate if administered more than 24 hours after an initial IV dose in patients who did not have nil per os status. Of the 200 patients studied, 31% were administered potentially inappropriate IV opioids at least once during their hospitalization, and 33% of all IV doses administered were potentially inappropriate. Given the numerous advantages of oral over IV opioids, this study suggests significant potential for improving prescribing practices to decrease risk of addiction, costs, and complications, ultimately improving the value of care provided.

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