1027. Tailored Empiric Antibiotic Prescribing Tool Addresses Gaps in Infectious Diseases Knowledge and Improves Trainee Prescribing Choices
Session: Poster Abstract Session: Stewardship: Implementing Programs
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDSA_Poster,_Empiric_Regimens, 9-23-13.pdf (161.5 kB)
  • Background:  Antimicrobial Stewardship Programs (ASP) assist prescribers select optimal antibiotic regimens based on presenting syndromes, host factors and local microbiology. Our objectives were to assess: 1) baseline infectious diseases (ID) knowledge among inpatient prescribers 2) the role of tailored educational tools on empiric prescribing.

    Methods: An anonymous pretest was administered to medicine residents and other providers at Montefiore Medical Center (MMC) accessing prescribing decisions on common ID clinical scenarios.  The medicine teaching service consists of over 150 residents in 3 distinct firms. A before and after intervention comparative pilot study was performed (intervention group:  Firm 1 residents, controls: Firm 3 residents) from December 2012-April 2013.   The intervention comprised of an educational session and distribution of a pocket antibiotic algorithm (tailored to local microbiology) and MMC antibiograms.  Pre- and post- antibiotic selection “appropriateness” judged by ID physicians for a sampling of inpatients  was compared using bivariate analyses (analyses ongoing).  Firm1 was surveyed for acceptability.    

    Results: The mean score on the ID pretest was 36% for the 118 clinician participants; performance did not statistically differ among the provider types (p> 0.05).  Performance by syndrome was highly variable. Appropriateness of prescribing for 200 actual patients did not vary between the two firms pre-intervention.  However, Firm 1 residents had improved prescribing after the intervention compared to their prior performance and compared to the control firm.

    Antibiotic Appropriateness

    Firm 1(N=100)

    Firm 3 (N=100)

    p- value

    Pre-Intervention

    56

    58

    0.08

    Post- Intervention

    75

    --

    --

    p-value

    0.01

    --

    --

    The majority of Firm 1 residents found the pretest fair (100%), the educational session and tool helpful and use it  frequently (> 90%) .

    Conclusion: Identifying prescribing deficits can focus ASP efforts.  Educational programs using algorithms tailored to specific syndromes and local microbiology appear to have early success in improving antibiotic appropriateness and are acceptable to providers.  Our study serves as a pilot for developing antibiotic algorithms for wider prescribing populations.

    Priya Nori, MD1,2, Belinda Ostrowsky, MD, MPH1,2, Yi Guo, PharmD1,2, Philip Chung, PharmD, MS1,2, Shara Epstein, MD1,2, Jean Mensz, MD1,2, Shakara Brown, MPH1 and Iona Munjal, MD1,2, (1)Montefiore Medical Center, Bronx, NY, (2)Albert Einstein College of Medicine, Bronx, NY

    Disclosures:

    P. Nori, None

    B. Ostrowsky, None

    Y. Guo, None

    P. Chung, None

    S. Epstein, None

    J. Mensz, None

    S. Brown, None

    I. Munjal, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.