193. Improved Antimicrobial Use through a Computerized Physician Order Entry (CPOE) Pneumonia Order Set
Session: Poster Abstract Session: Antibiotic Stewardship
Friday, October 21, 2011
Room: Poster Hall B1
Background: Pneumonia order sets have been shown to improve mortality, cost and compliance with Joint Commission pneumonia core measures. The purpose of this study is to determine the impact of a computerized physician order entry (CPOE) pneumonia order set on appropriate antibiotic (abx) selection, duration and de-escalation. The order set was developed in 2009 for hospitalized patients (pts) and incorporates a decision support feature to determine type of pneumonia, Pseudomonas risk and severity of illness to guide empiric abx therapy.

Methods: A CPOE pneumonia order set was evaluated with a retrospective case-control study at an 850 bed academic tertiary care center. Providers of case pts used the order set, providers of controls did not. 100 pts were randomly selected for each group from all adults hospitalized with a primary diagnosis of pneumonia during the year 2010 and were matched for month of admission. Electronic medical records were examined for patient characteristics, diagnostic tests performed, empiric abx adherence to guidelines, bug-drug match for those with positive culture (cx) results, length of abx days, de-escalation at 72 hours, and in-hospital mortality.

Results: Gender, age (range 19-96), type of pneumonia (community-, healthcare-, ventilator-acquired), treatment setting (ICU vs ward) and chest x-ray findings were not significantly different between groups. 24 case and 31 control pts had positive culture results. None had a bug-drug mismatch. The order set group had improved abx regimens, fewer febrile days and decreased mortality (Table).

Table. Select Order Set Performance Characteristics

 

Order Set (n=100)

No Order Set(n=100)

p-value

Diagnotics performed

 

     Legionella urine antigen (for severe community-acquired pneumonia)

18

4

0.003*

     Blood cx

93

92

1.00

     Respiratory cx

42

52

0.20

Empiric abx guideline adherence

84

73

0.08

72 hour abx de-escalation

65

48

0.02*

Mean abx days

15.2

17.7

0.13

Mean febrile days

0.12

0.43

0.04*

In-hospital mortality

2

10

0.03*

*Denotes statistical significance

Conclusion: CPOE pneumonia order sets that incorporate clinical decision support can improve diagnostic testing, antimicrobial use and mortality. Further development of similar order sets may enhance antibiotic stewardship efforts.


Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Vera Luther, MD1, Manish Dave, MD2, John Williamson, PharmD3, James Beardsley, PharmD3, James Johnson, PharmD3 and Christopher Ohl, MD1, (1)IM-Section on Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC, (2)Wake Forest School of Medicine, Winston-Salem, NC, (3)Wake Forest Baptist Health, Winston-Salem, NC

Disclosures:

V. Luther, None

M. Dave, None

J. Williamson, None

J. Beardsley, None

J. Johnson, None

C. Ohl, Optimer: Scientific Advisor, Consulting fee
Ortho-McNeil: , Speaker honorarium
Pfizer: Speaker's Bureau, Speaker honorarium
BD-Gene Ohm: Consultant, Consulting fee

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.