Program Schedule

149
Impact of a  Clinical Decision Support Tool in the Emergency Department on Antimicrobial Prescribing Patterns for the Treatment of Pneumonia

Session: Poster Abstract Session: Antibiotic Stewardship
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC

Background:

The National Hospital Inpatient Quality Measures identifies community-acquired pneumonia (CAP) as a core measure. The Joint Commission and Centers for Medicare and Medicaid Services assess rates of compliance with the standards established for core measures. The primary objective of this project was to evaluate the impact of a clinical decision support (CDS) tool in our Emergency Department (ED) on the rate of guideline concordant empiric antibiotic selection for the treatment of CAP.

Methods:

To improve risk factor identification and appropriate antibiotic selection for CAP at Penn Presbyterian Medical Center, the pharmacy and ED collaborated with infectious diseases and informatics representatives in the development and implementation of an electronic antibiotic CDS tool.  This CDS tool was created within the ED's electronic medical record and computerized physician order entry system to guide empiric antibiotic selection for patients presenting with CAP.

To assess impact the pharmacy department conducted a pre-implementation and post-implementation, retrospective evaluation of patients that presented to the (ED) with a primary or secondary ICD-9-code indicative of pneumonia between 2/1/2012-4/30/2012 (pre-implementation control group) and 2/1/2013-4/30/2013 (post-implementation of the CDS tool).

Results:

Sixty-eight patients were included in the pre-implementation arm and 60 included in the post-implementation arm.

 

Pre

Post

p-value

Appropriate empiric antibiotic selection

      Total

36/68 (52.9%)

44/60 (73.3%)

<0.001

           ED discharge only

           Hospital admission

18/20 (90.0%)

18/48 (37.5%)

16/17 (94.1%)

28/43 (65.1%)

0.647

< 0.001

Excess antibiotic days (median)

0.5

0

 

Conclusion:

Results demonstrate that the implementation of a CDS tool to guide antibiotic selection in the Emergency Department significantly improved adherence to national guidelines and decreased days of excess antibiotics. This represents a low-maintenance and sustainable intervention.

In order to further validate the impact of clinicial decision support tools on patient outcomes, future studies with a larger patient population should be developed.

Figure 1:

Danielle Evans, PharmD1, Nishaminy Kasbekar, PharmD, FASHP2, Judith O'donnell, MD3, Tanya Dougherty, PharmD, BCPS2, Richard Maniglia, MD3, Christian Boedec4, Christopher Edwards, MD4 and Amanda Binkley, PharmD, AAHVIP2, (1)Pharmacy, Massachusetts General Hospital, Boston, MA, (2)Pharmacy, Penn Presbyterian Medical Center, Philadelphia, PA, (3)Infectious Diseases, Penn Presbyterian Medical Center, Philadelphia, PA, (4)Emergency Department, University of Pennsylvania Health System, Philadelphia, PA

Disclosures:

D. Evans, None

N. Kasbekar, None

J. O'donnell, None

T. Dougherty, None

R. Maniglia, None

C. Boedec, None

C. Edwards, None

A. Binkley, None

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