231. Evaluation of the Effect of Automatic Stop Orders on Antibiotic Usage in a Pneumonia Protocol
Session: Poster Abstract Session: Antimicrobial Stewardship in Clinical Practice
Friday, October 21, 2011
Room: Poster Hall B1
  • 231_RachelGoodman.pdf (739.1 kB)
  • Background:  Protocols have been implemented based on published guidelines to provide health care practitioners with clinical decision support to optimize clinical outcomes while reducing the risk of errors and adverse reactions. An adult pneumonia protocol, in effect at UPMC Hamot since 2004, was revised in March 2010 to incorporate an automatic stop order on empiric antibiotics.  The intent was to prompt physicians to re-evaluate the patients’ clinical status and microbiological data for the most appropriate therapy. The purpose of this study was to evaluate the impact of the automatic stop order on antibiotic usage. 

    Methods:  Electronic charts were reviewed retrospectively for patients with an ICD-9 code of pneumonia during October-December 2009 (before implementation of the automatic stop order) and corresponding months in 2010 (after implementation).  A total of 150 patients were included in the study, 75 in each year.  Charts were reviewed for duration of empiric and total antibiotic therapy, de-escalation, and proportion of eligible therapy converted from parenteral to oral therapy.  Data was analyzed by Student’s T-test and Z-test.       

    Results:  Implementation of the automatic stop order resulted in a significant decrease in days of empiric therapy (4.55 days vs. 3.59 days, p<0.01) as well as in a decrease in total days of antibiotic therapy (6.63 days vs. 6.16 days, p=0.35).  The proportion of patients eligible for de-escalation that were de-escalated was significantly higher following implementation of the automatic stop order (63.2% vs. 91.7%, p<0.01).  The proportion of patients eligible for oral conversion that were converted was also significantly higher following implementation of the automatic stop order (69.1% vs. 83.9%, P<0.03).

    Conclusion:  Implementation of an automatic stop order to the pneumonia protocol resulted in a statistically significant decrease in the duration of empiric antibiotic therapy, a decrease in total days of antibiotic therapy and an increase in de-escalation and conversion of intravenous to oral antibiotics. An automatic stop order in antibiotic treatment protocols seems to be a useful tool in prompting health care practitioners to re-evaluate antimicrobial therapy.

    Subject Category: J. Clinical practice issues

    Rachael Goodman, Pharm.D., Gloria Aggrey, MD, Mary Lourdes Brundige, BS, Pharm.D. and Emily Shears, MPH, UPMC Hamot, Erie, PA


    R. Goodman, None

    G. Aggrey, None

    M. L. Brundige, None

    E. Shears, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.