198. Pharmacist-Led Antimicrobial Prompting During Interdisciplinary Team Rounds as a Novel Antimicrobial Stewardship Intervention. (26th November 2018)

• Record Type: Journal Article
• Authors: Skinner, Alisha; Young, Heather; Shihadeh, Kati; Knepper, Bryan; Jenkins, Timothy C
• Is Part Of: Open forum infectious diseases. Volume 5(2018)Supplement 1
• Page Start: S86
• Page End: S87
• Publication Date: 2018-11-26
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofy210.211
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: There is a need to develop successful antibiotic stewardship interventions that do not require ID physicians. Our hospital implemented a pharmacist-driven intervention to prompt critical assessment of antibiotic regimens during interdisciplinary team rounds. We evaluated the acceptance of this intervention and the effects on concordance with institutional prescribing guidance. Methods: This quality improvement initiative took place between November 2016 and June 2017 on a medical ward in an urban, level 1 trauma, public teaching hospital. During interdisciplinary team rounds, if the medicine team's antimicrobial choice was not concordant with institutional prescribing guidance, the clinical pharmacist made a recommendation. We assessed prescribing for urinary tract infection, skin and soft-tissue infection, and pneumonia pre- and post-intervention. Prescribing was classified as overall guideline-concordant if the antibiotic choices and duration of therapy were consistent with institutional guidance. Results: Thirty cases from each period were evaluated. Recommendations to the medical team were made on 63% (92/146) of days and on 31% (205/664) of patients on antibiotics. The most common recommendation was regarding days of therapy (Figure 1). The recommendations were accepted in 76% (156/205) of cases. (Figure 2). There were improvements in both the inpatient (70% to 83%, P = 0.22) and discharge (64% to 86%, P = 0.35) antibiotic choices and overall guideline concordance (53% to 63%, P = 0.43); however, these were not statistically significant. Concordance with duration of therapy was similar between the periods (76% vs. 77%, P = 0.94) (Figure 3). Conclusion: During interdisciplinary rounds, prompting by pharmacists to critically assess antibiotic regimens is a feasible antibiotic stewardship intervention that does not require ID expertise, is generally accepted by physicians, and may increase guideline-concordant antibiotic selection. Disclosures: All authors: No reported disclosures.