452. A Stepwise Approach to Antimicrobial Stewardship- Good for Prescribing and Fellows
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Montefiore Medical Center (>1000 beds, 2 campuses) is developing an antimicrobial stewardship program (ASP). Until 9/08, restricted antibiotic requests were reviewed by ID fellows. Consults are ordered on the hospital computer. Goals were to study antimicrobial requests/use, the approval system, and its impact on our ID fellows.
Methods: In 2009, a series of interventions were added to our approval system: 1) call triaged by clerical staff; 2) weekday restricted antibiotic requests taken by ASP (ID PharmDs/attendings); 3) web based text paging system for antibiotic requests. Calls to the ID pager were audited using standardized forms and tallied in Microsoft Access/SPSS, (3/30/09-5/15/09) and compared to baseline (9/08). Perceptions of ID MDs were obtained. Outcome/cost analyses are ongoing.
Results: Baseline-880 beeper calls were received (larger campus), including 519 calls weekdays (daytime): 44% restricted antibiotic requests, 20% follow-up requests, 17% unnecessary, 11% informal “advice” without consultation, 4% consults and 4% other.
Post intervention-302 calls were received by triage staff and 707 by ASP [474 (67%) via text, 149 (21%) from triage staff, 84 (12%) via other methods] from 2 campuses. ASP calls: 70% approvals, 13% “advice,” 10% follow-up requests, 4% unnecessary, 1% consults and 2% other. ASP approved 75% restricted antibiotics, however only 10% were approved exactly as requested (90% combination of: dosing/interval/route/duration adjustment, suggested work-up, contingent on consult, and/or prescriber education). The majority (85%) of approvals for empiric course were for < 3 days. ASP were less likely to approve (75% vs. 90%, p=0.02) and for shorter empiric duration (3% vs. 41%, p< 0.0001 for approvals > 5 days) than fellows during baseline period. Calls to ASP prompted 79 formalized ID consults. ID MDs identified time saving (1-3 hrs daily per ID fellow), more efficient rounds/consultation and better morale compared to past.
Conclusion: Outcomes from our stepwise model of stewardship using technology and a multidisciplinary approach are still preliminary, but show promise in improving antibiotic use and fellows’ efficiency.
Philip Chung, PharmD1, Yi Guo, PharmD, Ira Leviton, MD1, Belinda Ostrowsky, MD, MPH3 and  B. Ostrowsky, None..
Y. Guo, None..
P. Chung, None. 
I. Leviton,
Pfizer Role(s): Speaker's Bureau, Received: Speaker Honorarium, Consulting Fee.
Astellas Role(s): Speaker's Bureau, Received: Speaker Honorarium, Consulting Fee.
Wyeth Role(s): Speaker's Bureau, Received: Speaker Honorarium, Consulting Fee.
Cubist Role(s): Speaker's Bureau, Received: Speaker Honorarium, Consulting Fee., (1)Montefiore Medical Center, Bronx, NY, (2)Infectious Diseases, Montefiore Medical Center, Bronx, NY