971. Antimicrobial Prescription Surveillance System – APSS: a Persistent Impact after 20 Months of Use
Session: Poster Abstract Session: Stewardship: Epidemiology of Antibiotic Use
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Background: Antimicrobial (Abx) Stewardship Programs have been identified as a key factor to reduce avoidable adverse effects, resistance, and costs. Hospital-wide surveillance requires the revision of an overwhelming amount of data. We have developed and implemented a computerized Abx Prescription Surveillance System (APSS) to facilitate this process. APSS asynchronously identifies mismatches between posology and guidelines for creatinine clearance and weight. Length of treatment and route of administration are also evaluated. APSS identifies every potentially inadequate dose and alerts a pharmacist. The pharmacist contacts the prescribing physician and suggests an alternate posology or treatment discontinuation. The aim of this study was to evaluate the persistent impact of APSS use on Abx consumption and costs. 

Methods: Data was extracted from the clinical data warehouse of our 712-bed academic centre. The study included all hospitalized adults receiving ATM from August 2010 to April 2012. APSS was used 15 hrs/week by a pharmacist until October 2011.  After this first evaluation period, APSS was fully integrated and used 35 hrs/week. We chose days of therapy (DOT) per 1000 patient-days (PD) of hospitalization to measure Abx consumption. Interrupted time-series analysis was used to evaluate the impact of the intervention.

Results: A total of 392 494 PD and 114 086 DOT was monitorized during the study period. When we compared the base level of Abx consumption to what we have reached on the second year, we measured an overall reduction of 11 DOT/1000PD. This reduction came from the reduction of 45 DOT/1000PD of intravenous Abx. Using fixed Abx cost we have demonstrated a cumulative reduction of 705 000$ in Abx spending. Interrupted time series analyses with one degree of differentiation have shown an association between the intervention and the reduction of Abx consumption. A total of 2718 recommendations were accepted, with a 91% acceptance rate.

Conclusion: Considering steadily increasing costs of Abx in our centre (5% per year), our intervention reduced Abx expenses by 705 000$. Further analyses are required to evaluate the impact of our intervention on Abx resistance. Almost two years after APSS implementation, the positive impact of our intervention persists.

Vincent Nault, B.Sc.1, Mathieu Beaudoin, M.Sc.2, Julie Perron, B.Pharm., M.Sc.3 and Louis Valiquette, MD, MSc1, (1)Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Sherbrooke, QC, Canada, (2)Department of Computer Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada, (3)Department of Pharmacy, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada

Disclosures:

V. Nault, LUMED Inc.: co-founder and CEO, Salary and Stock options

M. Beaudoin, LUMED Inc.: Co-founder and CTO, Salary and Stock options

J. Perron, None

L. Valiquette, LUMED Inc.: co-founder and CMO, Stock option

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