1010. Antimicrobial Stewardship Initiative to Evaluate Indications for Antimicrobial Ordering
Session: Poster Abstract Session: Stewardship: Implementing Programs
Friday, October 4, 2013
Room: The Moscone Center: Poster Hall C
Background:

The Centers for Medicare and Medicaid Services (CMS) has been piloting a draft survey for accreditation of hospitals which includes a requirement to provide a diagnostic indication whenever an antimicrobial agent is ordered.  The Antimicrobial Stewardship Program (ASP) at the Ohio State University Wexner Medical Center (OSUWMC), in anticipation of this survey, implemented this requirement for targeted agents in a computerized order entry system (COE).

Methods:

COE at OSUWMC requires an indication be listed for 4 targeted antibiotics (ertapenem, linezolid, daptomycin, piperacillin-tazobactam [PT]). Prescribers are required to indicate via check boxes the reason for prescribing the targeted drugs. Reasons are based on current guidelines and evidence-based practices.  “Additional clinical indications (Other)” where free text must be entered is also an option.  From January 1 to February 28, 2013 data on the first order dispensed per patient of these targeted agents were gathered and the associated indications analyzed. 

Results:

The most commonly used indications were tabulated.  Ertapenem: surgical prophylaxis-colorectal procedure/ruptured viscous (33%), intra-abdominal infections (32%), Other (21%); Daptomycin: Other  (43%), osteomyelitis-vancomycin allergy/toxicity (16%), VRE bacteremia/endocarditis (15%), MRSA bacteremia-vancomycin ≥6 weeks in past (13%); Linezolid: MRSA pneumonia-suspected/confirmed (30%), Other  (22%), VRE-no alternative (15%); PT: empiric therapy (90%) and Additional clinical indications (5%).  The Additional Clinical Indications category contains free text entries which are being systematically analyzed.

Conclusion:

Understanding the indications for antimicrobial prescribing is the first step in assessing appropriateness of therapy.  We demonstrate that requiring an indication be listed at the time of COE prescribing is feasible.  This initial analysis of first orders per patient indicates a high empiric use of PT and many “Other ” selection for daptomycin, linezolid, and ertapenem.   Feedback auditing at 48-72 hours for cases without a clear indication may promote streamlining of therapy.  Further research is needed on linking these data to clinical outcomes and to understand how this intervention can be further leveraged to improve prescribing.

Jeremy Taylor, PharmD, BCPS1, Jessica E. West, MSPH2, Meredith Deutscher, MD3, Mark Lustberg, MD, PhD3, David Smeenk, RPh4, Crystal Tubbs, Pharm D5 and Kurt Stevenson, MD, MPH6, (1)Pharmacy, The Ohio State University Medical Center, Columbus, OH, (2)Infectious Diseases, Antimicrobial Stewardship Program, The Ohio State University Wexner Medical Center, Columbus, OH, (3)Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, OH, (4)Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, (5)Pharmacy, The Ohio State University, Columbus, OH, (6)Ohio State University Wexner Medical Center, Columbus, OH

Disclosures:

J. Taylor, None

J. E. West, None

M. Deutscher, None

M. Lustberg, None

D. Smeenk, None

C. Tubbs, None

K. Stevenson, None

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