1008. Comparison of the Effectiveness of Two Methods of Antibiotic Formulary Restriction:  Front-end versus Back-end Approval of Piperacillin-Tazobactam (P-T)
Session: Poster Abstract Session: Stewardship: Implementing Programs
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
  • MacyHo-StephenJung_Poster-final.pdf (546.5 kB)
  • Background: One of the most commonly used methods of antibiotic stewardship is formulary restriction and preauthorization.  At the VA Long Beach Healthcare System, we have always had a front-end approval process whereby restricted antibiotics require approval from an Infectious Diseases (ID) Fellow or Attending before pharmacy verifies the order and releases the antibiotic.  P-T is the second most commonly prescribed antibiotic at our institution despite it requiring ID approval.  In November 2012, we implemented a back-end approval process for P-T whereby providers are allowed to prescribe P-T for any reason for three days only.  To continue P-T beyond three days, providers must page ID for approval.  The objective of our study was to compare the effectiveness of back-end approval versus front-end approval in decreasing the use of P-T and examine the effects on de-escalation and discontinuation rates. 
    Methods: Retrospective cohort study of patients who received P-T > 72 hours during front-end approval (11/1/11-2/29/12) and back-end approval (11/1/12-2/28/13). 
    Results: 245 patients received P-T during the front-end period and 246 during back-end. Days of therapy (DOT) per 100 patient days of care was 7.9 for the front-end period and decreased to 5.2 for the back-end (p<0.001).  Average length of therapy was similar in both groups.  The number of patients whose P-T was de-escalated or changed was 121/245 (49.4%) for front-end and 151/246 (61.4%) for back-end (p=0.008).  A trend toward an increased number of ID Consults was observed in the back-end approval group (p=0.08).  Clinical failure, microbiological eradication, 30-day mortality, and C. difficile rates and average hospital length of stay did not differ for both groups. 
    Conclusion: A back-end antibiotic approval process that allows physicians to prescribe P-T for three days and then requiring ID approval to continue P-T, effectively decreased P-T DOT and increased de-escalation rates.  Clinical outcomes were not adversely affected.
    Macy Ho, PharmD1, Stephen Jung, PharmD1 and David Webb, MD2, (1)Department of Pharmacy, VA Long Beach Healthcare System, Long Beach, CA, (2)Department of Medicine, VA Long Beach Healthcare System, Long Beach, CA


    M. Ho, None

    S. Jung, None

    D. Webb, None

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