Implementation of clinical audit to improve adherence to guideline-recommended therapy in acute coronary syndrome

Background Despite global consensus on the management of acute coronary syndrome (ACS), implementation of strategies to improve adherence of guideline-directed medical therapy (GDMT) remains sub-optimal, especially in developing countries. Thus, we aimed to assess the effect of clinical pharmacist-led clinical audit to improve the compliance of discharge prescriptions in patients admitted with ACS. It is a prospective clinical audit of ACS patients which was carried out for 12 months. The discharge prescriptions were audited by clinical pharmacists for the appropriateness in the usage of statins, dual antiplatelet therapy (DAPT), beta-blockers, and angiotensin-converting enzyme inhibitors (ACE-I)/angiotensin receptor blocker (ARB). A feedback report was presented every month to the cardiologists involved in the patient care, and the trend in the adherence to GDMT was analyzed over 12 months. Results The discharge prescriptions of 1072 ACS patients were audited for the justifiable and non-justifiable omissions of mandated drugs. The first-month audit revealed unreasonable omissions of DAPT, statin, ACE-I/ARB, and beta-blockers in 1%, 0%, 14%, and 11% respectively, which reduced to nil by the end of the 11th month of the audit–feedback program. This improvement remained unchanged until the end of the 12th month. Conclusions The study revealed that periodic clinical audit significantly improves adherence to GDMT in patients admitted with ACS.

Autonomous mobile robot for visual inspection of MEP provisions

Quality control inspection is an imperative procedure in the construction industry. During construction, to get the plaster clearance of a specified area, the quality control engineer has to validate the mechanical, electrical and, plumbing (MEP) provisions laid out in the construction site with an engineering drawing approved by the consultant. The proposed system illustrates the implementation of an autonomous mobile robot (AMR) for inspecting MEP provisions amidst the construction phase. Power distribution, heating, ventilation, air conditioning (HVAC), telecommunications, water supply, and drainage are few examples of MEP engineering subsystems. In this paper, the main focus is on the inspection of plumbing services. These include provisions for washbasin and faucet in washrooms and sink in the kitchen area. The feedback program generated gives the evaluation result on the count of plumbing provisions inspected.

37. Impact of a Vancomycin/Piperacillin-tazobactam Audit and Feedback Program

Background Vancomycin and piperacillin-tazobactam (VPT) combination therapy is associated with nephrotoxicity and provides broad-spectrum coverage that may be unnecessary. We conducted a pre-post implementation study to assess the impact of an audit and feedback program for VPT at our academic medical center. Methods Automated alerts were used to identify patients on VPT at the University of Washington Medical Center (UWMC)-Montlake (ML) and UWMC-Seattle Cancer Care Alliance (SCCA) hospitals. Baseline data was collected on patients from 1/20/20-6/2/20: electronic medical records were reviewed for antibiotic indication, duration, renal function, and presence of Infectious Disease (ID) consult. From 6/25/20-10/31/20, all patients on combination therapy without an ID consult were reviewed by the antimicrobial stewardship programs at ML and SCCA, respectively. If intervention was warranted, the ML steward discussed the case with the provider then documented the conversation. The SCCA steward, instead, discussed the case with the team pharmacist. The primary outcome was change in VPT duration post intervention. Secondary outcomes included nephrotoxicity rates and carbapenem escalation. Results Prior to the intervention, 66 ML and 33 SCCA patients were started on the combination compared to 110 ML and 50 SCCA patients post-intervention. Overall, 50% of ML and 14% of SCCA patients were on surgical primary services. Amongst ML patients, there was a decrease in patients on VPT for > 4 days (22 % to 8%), incidence of renal injury (30.3% to 10%), and percentage of ID consults (53.0% to 43.6%). Escalation to a carbapenem was stable (4.5% to 4.5%). In SCCA patients the percentage of patients on VPT for > 4 days decreased slightly (18.2% to 15.2%), incidence of renal injury was stable (18.2% to 18%), percentage of ID consults increased (45.5% to 50.0%), and escalation to a carbapenem was stable (12.1% vs 13.5%). Conclusion Prospective audit and feedback of VPT was associated with a decrease in duration and nephrotoxicity in ML but not SCCA patients. The difference in outcomes could be due to the patient populations, primary services, or intervention process. This study highlights the importance of tailoring interventions even within the same medical system. Disclosures All Authors: No reported disclosures

Evaluation of the Special Olympics Team Wellness health promotion program for individuals with intellectual disabilities

Introduction: Individuals with intellectual disabilities are a known health disparities group. The Team Wellness (TW) health promotion program was developed to provide healthy lifestyle information to target this population. The purpose of this study was to conduct a qualitative program evaluation on Team Wellness. Methods: Interviews were conducted via one-on-one format with program coaches (n = 4, mean age = 25, female = 2, male = 2) and focus group with program athletes (n = 6, mean age = 45, female = 4, male = 2) who completed the TW program. Results: Themes that emerged included: (1) Program Perceptions; (2) TW Support; and (3) Program Feedback. Program perceptions were positive and continued athlete participation was anticipated. Coaches felt prepared to facilitate based on previous experience though program fidelity varied. Conclusion: Study participants enjoyed TW and identified valuable recommendations. Program fidelity and marketing efforts are important for future consideration. Further quantitative assessment is needed to determine the effectiveness the program.