987. Impact of the Expansion of an Established Antimicrobial Stewardship Program to Community Affiliate Hospitals by Utilization of the Electronic Health Record
Session: Poster Abstract Session: Stewardship: Implementing Programs
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Background: Vidant Health System is comprised of Vidant Medical Center (VMC) and nine community hospitals.  VMC is the central location of the antimicrobial stewardship program (ASP).   The affiliate community hospitals range from six to 102 beds.  The ASP program was expanded via the electronic health record (EHR) to four affiliate hospitals beginning in November 2011.    ASP pharmacists perform a daily remote EHR review of patients on antimicrobial therapy exceeding 24 hours.  A recommendation is left as a note in the EHR and/or direct physician communication.  Data on antimicrobial use have been collected quarterly and reflect before and after stewardship implementation.  We are reporting data from the two largest affiliate hospitals. 

Methods: This is a retrospective study to determine the impact of a remote stewardship program on antibiotic usage.  The EHR was used to generate the patient list and antimicrobial therapy was reviewed Monday – Friday.  Antimicrobial use was captured at time of administration by the electronic medication use record and measured in defined daily doses per 1000 patient days (DDD/1000PD).  Linear regression was used to determine statistically significant changes in antimicrobial use.  

Results: Adult inpatient days at hospitals 1 and 2 were 19241 and 5470 respectively.   A total of 3217 antimicrobials were reviewed and recommendations were made on 1841 (57%) of these orders.  The average physician acceptance rate was 89%. There were decreases in total antibiotic use at both institutions (1132 to 1005 DDD/1000 PD; p = 0.11 and 1748 to 1623 DDD/1000 PD; p = 0.05 for hospitals 1 and 2, respectively).  There was a significant decrease in quinolone use at both institutions (222 to 138 DDD/1000 PD; p = 0.001, and 370 to 114 DDD/1000 PD; p = 0.0007 for hospitals 1 and 2, respectively). 

Conclusion: The EHR is an effective tool to expand stewardship to offsite locations.  A centralized stewardship team from a remote location in conjunction with onsite champions is an option to optimize resources and increase appropriate use of antimicrobial agents.

Nichole Allen, PharmD, BCPS1, Paul Cook, MD2, Michael Gooch, MS, RPh1 and Michelle Jordan, PharmD1, (1)Pharmacy, Vidant Medical Center, Greenville, NC, (2)Medicine, East Carolina University, Greenville, NC


N. Allen, None

P. Cook, Merck: Grant Investigator and Speaker's Bureau, Research grant and Speaker honorarium
Gilead: Grant Investigator, Grant recipient
Pfizer: Grant Investigator, Grant recipient
Forest: Speaker's Bureau, Speaker honorarium

M. Gooch, None

M. Jordan, None

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