scholarly journals 1046. Evaluating the outcomes of embedding Antimicrobial Stewardship order sets in the General Medicine Admission Electronic Order Set: A Retrospective Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S368-S369
Author(s):  
April Chan ◽  
Ajay Kapur ◽  
Bradley Langford ◽  
Mark Downing
Keyword(s):  
Antimicrobial Stewardship ◽  
General Medicine ◽  
Fold Increase ◽  
Antibiotic Usage ◽  
Intervention Period ◽  
Post Intervention ◽  
Days Of Therapy ◽  
Order Sets ◽  
The Impact ◽  
Electronic Order

Abstract Background The use of facility-specific guidelines and clinical decision-making tools are recommended by a number of organizations to improve the appropriateness of empiric antimicrobial prescribing; however, how to increase usage is not clear. We evaluated the impact of embedding antimicrobial stewardship (AS) electronic order sets (EOS) into the general medicine admission EOS in the context of an established AS program. Methods The standalone EOS for community-acquired pneumonia (CAP), urinary tract infection (UTI) and cellulitis were reviewed and simplified to only include the antibiotic section prior to embedding. The intervention was introduced on March 30, 2017 with pre-intervention period defined as January 1, 2016 to March 29, 2017 and post-intervention period as of March 30, 2017 to June 30, 2018. The primary outcome was the change in usage of embedded AS EOS compared with the corresponding standalone EOS using counts. In addition, other standalone AS EOS (i.e., Clostridioides difficile infection (CDI), etc) were used as a control. The secondary outcomes were the change in antibiotic usage de-emphasized in embedded EOS (i.e., ceftriaxone, ciprofloxacin, clindamycin, moxifloxacin) and predicted prescribing shifts to antibiotics in the embedded EOS (i.e., amoxicillin-clavulanate, azithromycin and sulfamethoxazole-trimethoprim) using Days of Therapy (DOT)/1000 patient-days (PD). Paired t-test was used to compare antibiotic usage pre- and post-intervention. Results The usage of standalone EOS remained similar pre- and post-intervention except for a 16-fold increased usage of CDI EOS. There were large increases in uptake of the embedded EOS compared with the standalone EOS: 11-fold () increase for CAP, 47-fold () increase for UTI and 24-fold () increase for cellulitis. In addition, there was a statistically significant decrease in ciprofloxacin (mean 16.6 DOT/1000-PD vs. 13.6 DOT/1000-PD, P = 0.026) and moxifloxacin usage (mean 9.3 DOT/1000-PD vs. 5.2 DOT/1000-PD) during the study time period. Conclusion Our study showed that simplifying AS EOS and embedding these into a more commonly used EOS is associated with a significant increase in EOS usage and uptake of AS recommended empiric antibiotics with a decrease in fluoroquinolone usage. Disclosures All authors: No reported disclosures.

scholarly journals 1044. Impact of Interdisciplinary Rounds on Antimicrobial Use at a Community Hospital

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S368-S368
Author(s):  
Emma Castillo ◽  
Luke Heuts ◽  
Elizabeth Dodds Ashley ◽  
Rebekah W Moehring ◽  
Michael E Yarrington ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Community Hospital ◽  
Hospital Setting ◽  
Antimicrobial Use ◽  
Intervention Period ◽  
Post Intervention ◽  
Post Intervention Period ◽  
Interdisciplinary Rounds ◽  
Days Of Therapy ◽  
The Impact

Abstract Background Antimicrobial stewardship (AS) implementation is challenging in resource-limited settings such as smaller community hospitals that may lack dedicated personnel resources or have limited access to infectious diseases experts with dedicated time for AS. Few studies have evaluated the impact of interdisciplinary rounds as a strategy to optimize antimicrobial use (AU) in the community hospital setting. Methods We evaluated the impact of interdisciplinary rounds in a 280-bed acute care nonteaching, community hospital with an established ASP. The primary outcome was facility-wide antibiotic utilization pre- and post-implementation. Rounds included key healthcare personnel (hospitalists, clinical pharmacists, case managers, nurses) reviewing all patients on inpatient wards Monday through Friday, with a discussion of diagnosis, antibiotic selection, dosing, duration, and anticipated discharge plans. AU was compared for a 7-month post-intervention period (June 1, 2018–December 31, 2018) vs. similar months in 2017 based on days of therapy (DOT)/1,000 patient-days and length of therapy (LOT) per antimicrobial use admission. In addition, trends in AU for the post-intervention period were compared with the previous 17 months (January 1, 2017–May 31, 2018) using segmented binomial regression. Results Interdisciplinary rounds incorporating AS principles was associated with a decrease in overall AU in this facility, with a significant decrease of 16.33% (P < 0.0001) in DOT/1,000 pd in the first month and was stable (decrease of 1.1% per month, P = 0.15) thereafter (Figure 1). There was no significant change in LOT/admission after the first month of the intervention, but the trend demonstrated a 2% per month decrease (P < 0.03) thereafter (Figure 2). Comparing 2018 intervention months with similar months of 2017, the use of antibacterial agents decreased on average by 191.3 (95% CI −128.2 to −254.4) DOT/1,000 patient-days (Figure 3) and 0.546 (95% CI: −0.28 to −0.81) days per admission (Figure 4). Conclusion In this community hospital with an existing antimicrobial stewardship program, implementation of interdisciplinary rounds was associated with a substantial decrease in antimicrobial use. This was sustained for at least a 7-month period. Disclosures All authors: No reported disclosures.

scholarly journals Implementation of a Rapid Phenotypic Susceptibility Platform for Gram-Negative Bloodstream Infections With Paired Antimicrobial Stewardship Intervention: Is the Juice Worth the Squeeze?

2021 ◽  
Author(s):  
Evan D Robinson ◽  
Allison M Stilwell ◽  
April E Attai ◽  
Lindsay E Donohue ◽  
Megan D Shah ◽  
...  
Keyword(s):  
Median Time ◽  
Antimicrobial Stewardship ◽  
A Priori ◽  
Bloodstream Infections ◽  
Standard Of Care ◽  
Post Intervention ◽  
Gram Negative ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
The Impact

Abstract Background Implementation of the Accelerate PhenoTM Gram-negative platform (RDT) paired with antimicrobial stewardship program (ASP) intervention projects to improve time to institutional-preferred antimicrobial therapy (IPT) for Gram-negative bacilli (GNB) bloodstream infections (BSIs). However, few data describe the impact of discrepant RDT results from standard of care (SOC) methods on antimicrobial prescribing. Methods A single-center, pre-/post-intervention study of consecutive, nonduplicate blood cultures for adult inpatients with GNB BSI following combined RDT + ASP intervention was performed. The primary outcome was time to IPT. An a priori definition of IPT was utilized to limit bias and to allow for an assessment of the impact of discrepant RDT results with the SOC reference standard. Results Five hundred fourteen patients (PRE 264; POST 250) were included. Median time to antimicrobial susceptibility testing (AST) results decreased 29.4 hours (P &lt; .001) post-intervention, and median time to IPT was reduced by 21.2 hours (P &lt; .001). Utilization (days of therapy [DOTs]/1000 days present) of broad-spectrum agents decreased (PRE 655.2 vs POST 585.8; P = .043) and narrow-spectrum beta-lactams increased (69.1 vs 141.7; P &lt; .001). Discrepant results occurred in 69/250 (28%) post-intervention episodes, resulting in incorrect ASP recommendations in 10/69 (14%). No differences in clinical outcomes were observed. Conclusions While implementation of a phenotypic RDT + ASP can improve time to IPT, close coordination with Clinical Microbiology and continued ASP follow up are needed to optimize therapy. Although uncommon, the potential for erroneous ASP recommendations to de-escalate to inactive therapy following RDT results warrants further investigation.

scholarly journals 102. Effects of an Antimicrobial Stewardship-guided MRSA Nasal Screening Review on Vancomycin Utilization for Respiratory Infections: A Quasi-Experimental Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S65-S65
Author(s):  
Ross Pineda ◽  
Meganne Kanatani ◽  
Jaime Deville
Keyword(s):  
Antimicrobial Stewardship ◽  
Respiratory Infections ◽  
Intervention Group ◽  
Small Sample ◽  
Post Intervention ◽  
Predictive Values ◽  
Days Of Therapy ◽  
Significant Difference ◽  
Quasi Experimental ◽  
The Impact

Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) remains a significant pathogen in patients with respiratory infections. Guidelines recommend empiric MRSA coverage in patients at increased risk, resulting in substantial vancomycin use. Recent literature highlights the use of MRSA nasal assays as a rapid screening tool for MRSA pneumonia, demonstrating high negative predictive values and allowing for shorter empiric coverage. We aimed to evaluate the impact of MRSA nasal screening review by the antimicrobial stewardship program (ASP) on vancomycin utilization for respiratory infections. Methods This was a retrospective, quasi-experimental, pre-post intervention study. The intervention saw the addition of an MRSA screening review tool into the ASP electronic record, highlighting patients on vancomycin (actively or recently administered) with a negative MRSA screening. Vancomycin days of therapy (DOT) was collected for all orders indicated for a respiratory infection in the two weeks following a negative screening. Additional outcomes include vancomycin total dose and DOT per 1,000 patient days. Outcomes were compared via independent samples t-tests. Results 1,110 MRSA screenings resulted across 2 months, of which the majority were excluded for either not having vancomycin ordered, or for having vancomycin ordered for a non-respiratory indication, leaving 37 and 35 evaluable screenings in the pre- and post-intervention groups, respectively. Regarding vancomycin DOT, we did not identify a significant difference between pre- and post-intervention groups with respective means of 2.45 (SD=1.52) and 2.14 (SD=1.12) (p=0.35). We identified a total 8.78 vancomycin DOT per 1,000 patient days in the pre-intervention group versus 6.69 in the post-intervention group. Conclusion ASP-guided review of MRSA screenings was associated with a nonsignificant decrease in mean vancomycin DOT and lower total DOT per 1,000 patient days for respiratory infections following a negative screen. Given the recent implementation of our intervention, our analysis covered a small sample size, highlighting the need for continued data collection. MRSA screenings are not always fully or immediately utilized in our institution, demonstrating room to de-escalate MRSA-targeted antibiotics. Disclosures All Authors: No reported disclosures

scholarly journals 1097. An Antimicrobial Stewardship Intervention to Optimize Cefazolin Dosing for Surgical Prophylaxis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S390-S390
Author(s):  
Elizabeth A Neuner ◽  
Jill Wesolowski ◽  
Kaitlyn R Rivard ◽  
Pavithra Srinivas ◽  
Andrea Pallotta ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Guideline Adherence ◽  
Antimicrobial Prophylaxis ◽  
Academic Medical Center ◽  
Dose Optimization ◽  
Surgical Prophylaxis ◽  
Post Intervention ◽  
Order Sets ◽  
The Impact ◽  
Order Set

Abstract Background Guidelines for antimicrobial prophylaxis in surgery recommend cefazolin dose be adjusted based on patient weight. Adults weighing ≥120 kg should receive a 3 g dose, all other adult patients should receive a 2 g dose pre-operatively. To promote guideline adherence, an antimicrobial stewardship pharmacist-driven dose optimization intervention was implemented. Methods Retrospective, pre (February 1, 2017–March 31, 2017)/post (February 1, 2018–March 31, 2018) study evaluating the impact of a pharmacist-driven cefazolin dose optimization intervention at a large health system. An alert within the electronic health record notified pharmacists during order verification when cefazolin dose from a surgical prophylaxis order set did not match weight-based recommendations. All patients with cefazolin orders for surgical prophylaxis were included; pediatric and pregnant patients were excluded. Results Pre-group included 9,830 patients, post-group 10,025 patients. In both groups, the mean age was 58 years, mean weight 87 kg, and 8% of patients weighed ≥120 kg. Approximately 21% of patients were seen at the academic medical center, 8% at ambulatory surgery centers, and the remainder amongst 10 community hospitals. Most common surgical procedure types were orthopedic (26%), general surgery (21%) and urologic (10%). Primary cefazolin dose was 2 g in 89.8% vs. 88.7%, followed by 3 g 6.6% vs. 6.9% and 1 g in 3.9% vs. 4.4%, pre- and post-intervention, respectively. Overall adherence to weight-based cefazolin dosing was 92.2% pre-group and 92.4% post-group. In patients weighing ≥120 kg, adherence improved from 62% (514/827) to 71% (582/817) post-intervention, P < 0.001. Adherence was better both pre- and post-intervention when an order set was used (pre: order set 95.0% vs. no order set 85.9%, P < 0.001; post: order set 96.4% vs. no order set 84.8%, P < 0.001). There were no differences between surgical services or hospital locations. Investigation of guideline nonadherent cases found order sets without updated dosing recommendations and allowed for targeted education efforts. Conclusion Overall adherence to cefazolin weight-based dosing recommendations for surgical prophylaxis was high, especially with the use of order sets. Pharmacist-driven dose optimization intervention improved guideline adherence in patients weighing ≥120 kg. Disclosures All authors: No reported disclosures.

scholarly journals 29. Impact of Antimicrobial Stewardship Intervention on Unrestricted Meropenem Use Upon Transitions of Care

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S137-S137
Author(s):  
Noor Zaidan ◽  
Rachel S Britt ◽  
David Reynoso ◽  
Emmanuel Enwere ◽  
Kathryn Rucker ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Transitions Of Care ◽  
Post Intervention ◽  
Levels Of Care ◽  
Days Of Therapy ◽  
The Impact ◽  
Surgical Unit ◽  
Continue Therapy

Abstract Background Broad-spectrum antimicrobials, like carbapenems, are often initiated empirically and can be continued for long periods of time, which may increase rates of multi-drug resistant organisms. Antimicrobial stewardship programs (ASP) have been shown to decrease the duration of antimicrobial therapy. Since July 2017 at UTMB Health, meropenem use has been restricted to infectious diseases and intensive care unit (ICU) providers. This study evaluated the impact of an electronic medical record (EMR)-based ASP intervention on meropenem days of therapy (DOT) in patients transitioning from the ICU to the general floors. Methods Patients aged at least 18 years with an active medication order for meropenem upon transition from an ICU to a medical/surgical unit were included. Once transitioned, the active meropenem order appeared in the “review” column of the pharmacists’ queue. Pharmacists contacted the primary team, requested infectious diseases or ASP approval to continue therapy, and documented communication in the chart. Data for the pre- and post-intervention groups was collected retrospectively for the months of November 2017 to April 2018 and March 2020 to August 2020. The primary outcome of the study was meropenem DOT after transition from the ICU to the medical/surgical unit. Secondary outcomes of the study included meropenem total DOT, total number of meropenem doses after transfer to the medical unit, 30-day all-cause mortality, and 30-day readmission. Results A total of 163 patients were evaluated in both the pre-intervention (n = 87) and post-intervention groups (n = 76). Median meropenem DOT after transition of care (3 days vs. 2 days, P = 0.0004) and number of meropenem doses after transition (6 doses vs. 4 doses, P = 0.014) were significantly lower after TOC intervention implementation. However, total meropenem DOTs were not different at 5 days in both groups. Recommendations for de-escalation or discontinuation were accepted 60% of the time among providers. Conclusion An EMR-based ASP intervention did decrease meropenem DOT after patients were transitioned from the ICU to the medical/surgical floors. Results of the meropenem EMR-based ASP intervention may be used to expand to other broad-spectrum antimicrobials/antifungals in patients transitioning levels of care. Disclosures All Authors: No reported disclosures

scholarly journals 39. Impact of Antimicrobial Stewardship Interventions in a Community Hospital setting: An Interrupted Times Analysis

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S141-S142
Author(s):  
Jason Li ◽  
Ken Chan ◽  
Hina Parvez ◽  
Margaret Gorlin ◽  
Miriam A Smith
Keyword(s):  
Antimicrobial Stewardship ◽  
Community Hospital ◽  
Hospital Setting ◽  
Interrupted Time Series ◽  
Antibiotic Use ◽  
Antimicrobial Use ◽  
Intervention Period ◽  
Prospective Audit ◽  
Post Intervention ◽  
The Impact

Abstract Background Community hospitals have fewer resources for antimicrobial stewardship programs (ASP) compared to larger tertiary hospitals. At our 312-bed community hospital, Long Island Jewish Forest Hills/Northwell, a combination of modified preauthorization, prospective audit feedback, and ASP education was implemented starting in August 2019 (Monday through Friday 9 am to 5 pm). Methods This retrospective study evaluated the impact of ASP interventions on the rate of targeted antimicrobial use over a 7 month pre- vs 7 month post- intervention period (Aug 2018 to Feb 2019 vs Aug 2019 to Feb 2020). Targeted antimicrobials included piperacillin-tazobactam, vancomycin, daptomycin, and carbapenems. The primary outcome was the monthly mean for overall targeted antimicrobial use measured by the rate of antimicrobial days per 1000 days present. Secondary outcomes were the individual rates of antimicrobial days per 1000 days present for each of the targeted antimicrobials, and the hospital’s overall standardized antimicrobial administration ratio (SAAR). Data were analyzed as a segmented regression of interrupted time series. Results Pre-intervention, there was an increasing trend (positive slope, p&lt; 0.05) in the monthly mean, hospital SAAR, vancomycin and piperacillin-tazobactam use. Post-intervention, there was a significant change in slope for these same metrics, indicating a decrease in the mean use. Immediate impact of ASP interventions, measured by the difference in antibiotic use between the end of each intervention period, was visually evident in all cases except carbapenems (Fig. 1 through 4). The immediate impact on the overall monthly mean represented a significant reduction in the rate of antimicrobial days per 1000 days present, -12.72 (CI -21.02 to -4.42, P &lt; 0.0066). The pre- vs post- ASP gap for all measures was negative and consistent with fewer days of antibiotic use immediately following intervention. Conclusion A targeted, multifaceted ASP intervention utilizing modified preauthorization, prospective audit feedback, and education significantly reduced antibiotic use in a community hospital. Disclosures All Authors: No reported disclosures

scholarly journals 83. Staff Pharmacist-driven Prospective Audit and Feedback at a Community Hospital: Assessing an all Hands on Deck Approach to Antimicrobial Stewardship

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S58-S59
Author(s):  
Casey J Dempsey ◽  
Natasha Weiner ◽  
Michele Riccardi ◽  
Kristin Linder
Keyword(s):  
Antimicrobial Stewardship ◽  
Community Hospital ◽  
Audit And Feedback ◽  
Small Community ◽  
Prospective Audit ◽  
Post Intervention ◽  
Days Of Therapy ◽  
Prospective Audit And Feedback ◽  
The Impact ◽  
Feedback Program

Abstract Background Facilities with robust antimicrobial stewardship programs often have infectious disease (ID) pharmacists with devoted time to complete antimicrobial stewardship initiatives. Smaller facilities with limited resources or lacking ID pharmacists, may encounter challenges meeting antimicrobial stewardship regulatory requirements. The goal of this study is to assess the impact of a staff pharmacist-driven prospective audit and feedback program in a small community hospital. Methods A pre- and post-intervention study was performed to assess the primary outcome of days of therapy per 1,000 patient days (DOT) for targeted antimicrobials (ciprofloxacin, levofloxacin, piperacillin/tazobactam, cefepime, ceftazidime). Secondary outcomes were antibiotic expenditures and rates of Clostridioides difficile infection (CDI). Results Significant decreases in DOT were observed for piperacillin/tazobactam (29.88 vs. 9.25; p &lt; 0.001), ciprofloxacin (23.22 vs. 9.97; p &lt; 0.001), levofloxacin (11.2 vs. 5.07; p &lt; 0.001) and overall antipseudomonal DOT (62.91 vs. 51.67; p &lt; 0.001). There was no difference in ceftazidime DOT (8.75 vs. 6.47; p= 0.083) and an increase in cefepime DOT (20.47 vs. 34.35; p &lt; 0.001). A trend towards decreased rates of CDI was seen (4.9/10,000 patient days vs. 2.64/10,000 patient days; p= 0.931). There were significant decreases in antibiotic expenditures for piperacillin/tazobactam ($52,498 vs. $10,937; p &lt; 0.001), levofloxacin ($2,168 vs. $672; p &lt; 0.001), ciprofloxacin ($6,700 vs. $1,954; p &lt; 0.001). Lower expenditures for ceftazidime were seen ($9,952 vs. $7,457; p= 0.29). Cefepime expenditures increased ($25,638 vs. $40,097; p= 0.001). An overall decrease in the expenditure for the targeted antibiotics was seen ($95,715 vs. $62,837; p &lt; 0.001). Conclusion Implementation of a staff pharmacist-driven prospective authorization and feedback program led to a significant decrease in DOT and antibiotic expenditures for several targeted antibiotics and a trend towards decreased rates of CDI. Despite increased DOT and expenditures for cefepime, there was an overall decrease amongst the targeted antibiotics. With proper implementation, staff pharmacists can significantly benefit antimicrobial stewardship initiatives. Disclosures All Authors: No reported disclosures

scholarly journals 1075. The Impact of Physician Peer Comparison of a Novel Inpatient Antimicrobial Stewardship Metric: the Start-Stop Ratio (SSR)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S381-S381
Author(s):  
Stacy Volk ◽  
Michelle Fagenstrom
Keyword(s):  
Antimicrobial Stewardship ◽  
High Ratio ◽  
Antibiotic Prescribing ◽  
Post Intervention ◽  
Entire Study ◽  
Diagnostic Uncertainty ◽  
Open Disclosure ◽  
Days Of Therapy ◽  
Significant Difference ◽  
The Impact

Abstract Background The 48-hour “Antibiotic Timeout” (ATO), one of the CDC’s interventions defined in the Core Elements of Antimicrobial Stewardship Programs (ASP), has not reliably proven to impact inpatient antibiotic use. Given the reported history of utilizing peer-comparison data to change prescribing behavior, it was hypothesized that open disclosure of individual inpatient antibiotic start-stop ratios (SSR) would be an effective tool to increase prescribers’ tendency to (1) observe patients off antibiotics upon admission while pursuing treatments perceived more likely to provide syndromic resolution and (2) discontinue antibiotics in the setting of diagnostic uncertainty at 48 hours, or possibly even earlier, without introducing harm. Methods In a community, nonteaching hospital, all adult systemic antibiotic orders initiated by an inpatient hospitalist with at least one administration during the baseline period of January - March of 2018 were retrieved. A prescriber-specific count of all antibiotic orders (“starts”) and discontinuations (“stops”) was collected. Each provider received a document with their baseline SSR compared with the group SSR and was assigned a visual cue that corresponded to the quartile in which they performed at baseline. The same antibiotic data were then collected and evaluated for the post-intervention period of February–April 2019 to determine whether open disclosure of inpatient SSRs impacted antibiotic prescribing. Results Of 19 providers that were included in both study periods, there was no significant difference in the pre- and post-intervention SSR (1.93 to 2.09, P = 0.19). However, in the pre-intervention high-ratio target group (n = 10) for whom we felt open SSR reporting would impact the most, the SSR decreased from 2.41 to 2.26 (P = 0.24). In the entire study population, 68% of providers had a reduction or no change in their SSR. Overall facility-wide antibiotic utilization decreased from 561 to 478 days of therapy per 1,000 days present (P < 0.05). Conclusion Open reporting of antibiotic SSRs to an inpatient provider group may be utilized as an ASP tool to reduce overall inpatient antibiotic consumption, especially by providers that are found to be high-ratio prescribers at baseline. Disclosures All authors: No reported disclosures.

scholarly journals 2103. Emergency Department (ED) Stewardship: Stratifying ED Sepsis Order Sets by Penicillin (PCN) Allergy Severity

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S711-S712
Author(s):  
Mary L Staicu ◽  
Maryrose R Laguio-Vila ◽  
Allison Ramsey ◽  
Kelly M Conn ◽  
Kristin Woodring
Keyword(s):  
Intervention Group ◽  
Hospital Length Of Stay ◽  
Antibiotic Prescribing ◽  
Hypersensitivity Reactions ◽  
Post Intervention ◽  
Days Of Therapy ◽  
Order Sets ◽  
The Impact ◽  
Post Intervention Group ◽  
Order Set

Abstract Background The Surviving Sepsis Campaign Guidelines recommends administration of broad-spectrum antibiotics within 1 hour of sepsis diagnosis; electronic order sets drive antibiotic selection with pre-populated regimens based on the suspected infectious indication. Given the low rate of cephalosporin cross-reactivity in patients with a PCN allergy, we modified our ED sepsis order set (Images 1 and 2) to include cephalosporin options in patients with reported mild-to-moderate PCN reaction histories. This was a single-center, retrospective analysis evaluating the impact of this change on antibiotic prescribing and associated outcomes. Methods An electronic medical record (EMR) report identified patients ≥18 years of age with a documented PCN allergy that received antibiotics via the ED sepsis order set from December 30, 2012 to September 28, 2013 (pre-intervention) and January 3, 2014 to July 18, 2015 (post-intervention). The primary objective was to compare antibiotic days of therapy (DOT) and length of therapy (LOT) between the pre- and post-groups. The secondary objectives included 30-day readmission and mortality, hospital length of stay (LOS), incidence of C. difficile within 6 months and documented hypersensitivity reactions. Bivariate analyses, with chi-square, Mann–Whitney U, and Poisson means test, were used. Results A total of 180 patients (90 pre- and 90 post-intervention) were included. Demographics were similar between groups, with the exception of congestive heart failure (CHF) which was more prevalent in the post-intervention group (P = 0.039). Aztreonam, vancomycin, aminoglycoside, and fluoroquinolone DOTs were significantly reduced (P &lt; 0.001) while cephalosporin DOTs significantly increased (P &lt; 0.001) in the post-intervention group. There were no statistical differences in antibiotic LOT, 30-day readmission and mortality, hospital LOS, or incidence of C. difficile infection. For those patients that received cephalosporin antibiotics, there were no hypersensitivity reactions documented in the EMR. Conclusion Stratifying ED sepsis order sets by PCN allergy history severity is a safe and effective intervention that reduces second-line antibiotics in PCN allergic patients presenting to the ED with suspected sepsis. Disclosures All authors: No reported disclosures.

scholarly journals 2085. Bedside Nurses Improve Antimicrobial Stewardship and Infection Prevention Outcomes: Results of a 3.5-Year Study in Three Hospital Telemetry Units

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S704-S704
Author(s):  
David Ha ◽  
Mary Bette Forte ◽  
Victoria Broberg ◽  
Rita Olans ◽  
Richard Olans ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Infection Prevention ◽  
Medical Center ◽  
Bloodstream Infections ◽  
Urinary Catheters ◽  
Bedside Nurse ◽  
Post Intervention ◽  
Days Of Therapy ◽  
Tract Infections ◽  
The Impact

Abstract Background Minimal literature exists to demonstrate the quantitative impact of bedside nurses in antimicrobial stewardship (AMS). We initiated bedside nurse-driven AMS and infection prevention (AMS/IP) rounds on three inpatient telemetry units of a community regional medical center. Rounds were nurse-driven, involved an infectious diseases (ID) pharmacist and infection preventionist, and were designed to complement traditional ID pharmacist and ID physician AMS rounds. Rounds were focused on use of antibiotics, urinary catheters (UCs), and central venous catheters (CVCs). Recommendations from rounds were communicated by the bedside nurse either directly to providers or to the ID pharmacist and ID physician for intervention. Methods This was an observational, multiple-group, quasi-experimental study conducted over 3.5 years (July 2015 to December 2018) to characterize the impact of bedside nurse-driven AMS/IP rounds on antibiotic, urinary catheter and CVC use, hospital-onset C. difficile infection (CDI), catheter-associated urinary tract infections (CAUTI), and central line-associated bloodstream infections (CLABSI). Outcomes were assessed in two cohorts based on time of AMS/IP rounds implementation (Cohort 1 implemented on one telemetry unit in July 2016, Cohort 2 implemented in two telemetry units in January 2018). Results A total of 2,273 patient therapy reviews occurred (Cohort 1: 1,736; Cohort 2: 537). Of these reviews, 1,209 (53%) were antibiotics, 879 (39%) were urinary catheters, and 185 (8%) were CVCs. Pre- vs. post-intervention, significant reductions were observed in both cohorts for mean monthly antibiotic days of therapy per 1,000 patient-days (Cohort 1: 791 vs. 688, P < 0.001; Cohort 2: 615 vs. 492, P < 0.001), UC days per patient day (Cohort 1: 0.25 vs. 0.16, P < 0.001; Cohort 2: 0.19 vs. 0.14, P < 0.001), CVC days per patient day (Cohort 1: 0.15 vs. 0.11, = 0.002; Cohort 2: 0.09 vs. 0.07, p = 0.005), and CDI per 10,000 patient-days (Cohort 1: 17.8 vs. 7.1, p = 0.035; Cohort 2: 19.1 vs. 5.4, p = 0.003). Numerical reductions were observed in CAUTI and CLABSI per 10,000 patient-days. Conclusion Bedside nurses can improve AMS and IP outcomes in a scalable fashion when supported by an interdisciplinary AMS/IP team and are complimentary to traditional AMS and IP practices. Disclosures All authors: No reported disclosures.

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