455. Prior Authorization Encounters for Restricted Drugs in an Established Antimicrobial Stewardship Program
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: The antimicrobial stewardship program at WFUBMC utilizes prospective audit and feedback and drug prior authorization (PA) as recommended by the IDSA/SHEA guidelines. An encounter data form was implemented in order to better describe PA activities and develop future process measures.
Methods: The PA process at WFUBMC, an 878 bed tertiary medical center, was established in 2000 and is a core function of the ASP. Antimicrobials that require PA are selected due to complexity of use, concerns for development of antimicrobial resistance, or drug acquisition costs. Most PA antimicrobials are restricted for all inpatients and require paging a member of the ASP team (2 ID physicians and 2 ID PharmDs) prior to electronic physician order entry. PA may be given by the ID consult service only for patients they follow. For each PA encounter from Nov 2008-Jan 2009 data was collected by ASP team members that included requesting service, training level of caller, attending MD, geographic patient location, requested antimicrobial, reason for request, infection history of the patient, and PA recommendation.
Results: 257 PA encounters were recorded during the 3 month period. 105 (41%), 73 (28%), and 61 (24%) were from hematology/oncology, ICU, and general medicine services respectively. 75% of interactions were with upper level residents and interns. Requests for restricted antimicrobials accounted for 89% of encounters and general antimicrobial advice for the remainder. The most commonly requested restricted drugs were carbapenems (76), voriconazole (50), daptomycin (34), linezolid (20), and echinocandins (12). 81% of requested drugs were approved, while 19% were disapproved with recommendations made for de-escalation or a different drug. The median interaction time was 6 min (range 2-60 min). In 3 patients the approval process resulted in a delay in antimicrobial administration of 1-2 hours.
Conclusions: Collection of PA encounter data is a potentially useful process measure and can be used to target antimicrobial education and intervention. Well administered PA programs need not be time consuming and seldom delay antimicrobial administration.
James Beardsley, PharmD1, Jesse Couk, MD2, James Johnson, PharmD1, Vera Luther, MD2, Christopher Ohl, MD3, John Williamson, PharmD and  C. Ohl, None..
J. Couk, None..
J. Beardsley, None..
J. Johnson, None..
V. Luther, None..
J. Williamson, None., (1)Wake Forest University Baptist Medical Center, Winston-Salem, NC, (2)Wake Forest University Baptist Medical Center (WFUBMC), Winston-Salem, NC, (3)Wake Forest University Baptist Medical Center (WFUBMC), Winston Salem, NC