989. One Year Outcomes of an Antimicrobial Stewardship Program (ASP) in a Non-Teaching Community Hospital
Session: Poster Abstract Session: Stewardship: Implementing Programs
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Poster - Final (IDWeek 2013).pdf (623.6 kB)
  • Background:   Despite more than 80% of hospitals in the United States being a non-teaching community hospital, only a small percentage of hospitals have an Antimicrobial Stewardship Program (ASP).  Few published studies describe ASP outcomes in these clinical settings.  Blount Memorial Hospital is a 304 bed non-teaching community hospital with a formal pharmacist-led ASP that began in October 2011.  Data was analyzed to determine outcomes associated with the first year of the program.

    Methods:   Using prospective audit with intervention and feedback, all patients worked up by the ASP team from October 2011 through September 2012 were included in the data analysis.  Monthly utilization was calculated using Defined Daily Doses (DDD) per 1000 patient days with a cohort of 10 months immediately prior to initiating the ASP.  For antimicrobial expenditures, the fiscal year prior to initiating ASP was used as a cohort.  Statistical analyses performed were 2-tailed, 2-sample t-tests with unequal variances.

    Results:   In the first year, 507 patients were worked up with 81% (n=413) having at least one recommendation. A total of 763 recommendations resulted in an acceptance rate of 92%.  The top three recommendation categories were de-escalation (n=227), changes in duration (n=139), and IV to oral conversion (n=130).  The top three drugs affected by recommendations were piperacillin-tazobactam (n=123), linezolid (n=99), and vancomycin (n=93).  The ASP was directly responsible for initiating 19 infectious diseases (ID) consultations.  Piperacillin-tazobactam utilization decreased by 19% (DDD mean: 102 vs 83; p < 0.001) while linezolid utilization decreased by 39% (DDD mean: 32 vs 20; p = 0.003).  Overall antimicrobial expenditure decreased by $375,000 ($1,690,000 vs $1,315,000; 22%) from the previous fiscal year with a net savings of $231,000 after incorporating the costs of the program.  Antimicrobial cost decreased by $5.29 per patient day ($28.81 vs $23.52; 18%).

    Conclusion:   A pharmacist-led ASP in a non-teaching community hospital can optimize patient antimicrobial therapy while significantly improving antimicrobial utilization and overall antimicrobial expenditure.  The program was financially self sufficient and resulted in additional ID consultations.

    Brad Crane, Pharm.D., BCPS, Blount Memorial Hospital, Maryville, TN; Pharmacy, Blount Memorial Hospital, Maryville, TN

    Disclosures:

    B. Crane, None

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