1448. Sustainability of a Self-Stewardship Time-Out Program (SSTOP) for Vancomycin (VAN) and Piperacillin-Tazobactam (P-T) at a Veterans Affairs Medical Center
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions
Saturday, October 10, 2015
Room: Poster Hall
Background:

In 2013, our facility implemented a policy requiring self-renewal by providers upon completion of an antibiotic renewal template on day 4 for VAN and P-T. We assessed early and late response to the intervention.

Methods:

We assessed antibiotic utilization following SSTOP implementation and compared rates of guideline-discordant self-continuation of VAN or P-T through day 5 (as determined by expert chart review) before (6 months) and after (1 year) SSTOP implementation. We also compared rates of discordancy during the 1st (4-10/2013) and 2nd (10/13-4/14) 6 month periods of SSTOP, the latter when research support had been completed. 

Results:

Of 276 VAN time-out-eligible events, templates were completed in 127 (46%) and VAN was continued in 80 (29%). VAN was active through day 5 despite no template in 21 (7.6%). It was allowed to expire without a template in 128 (46%). 13 (4.7%) continuations of VAN via template were guideline-discordant vs. none before SSTOP (p=0.001).  Overall VAN discontinuation was higher during SSTOP than the pre-intervention period: 175/276 (63%) vs. 96/199 (48%) p=0.001.  More providers completed the VAN template in the 2nd 6 months compared to the 1st (54% vs 37%, p=0.0054) but VAN discontinuation was similar: 64% vs 63% (p=0.80).  There was no significant difference in inappropriate continuation between the 1st and 2nd 6 months for VAN: 4.8% vs. 4.5% (p=0.77).

Of 225 P-T time-out-eligible events, templates were completed in 115 (51%) and P-T was continued in 81 (36%). P-T was active through day 5 despite no template in 7 (1.9%).  It was allowed to expire without a template in 103 (46%). 22 (9.8%) continuations of P-T via template were guideline-discordant vs. 2/93 (2%) before SSTOP (p=0.019).  Overall P-T discontinuation was similar during SSTOP vs. pre-intervention: 137/225 (61%) vs 58/93 (62%), p=0.90. Between the 1st and 2nd 6 months, there was no significant difference in template use: 50% vs. 52% (p=0.69); discontinuation at day 5: 64% vs. 56% (p=0.085), or inappropriate continuation via timeout: 8.6% vs. 10.8% (p=1.0). 

Conclusion:

With SSTOP, VAN was discontinued more frequently, and guideline discordant continuations were infrequent.  These effects were sustained in the 2nd 6 months post-implementation during which research support for the program halted.

Hayden Lowenstein, M.D.1,2, Matthew Bidwell Goetz, MD3, Makoto Jones, MD, MS4, Peter Glassman, MBBS, MSc5, Matthew Samore, MD, FSHEA6 and Christopher Graber, MD, MPH, FIDSA2, (1)Cedars-Sinai/UCLA multicampus program in Infectious Disease, Los Angeles, CA, (2)VA Greater Los Angeles Healthcare System, Los Angeles, CA, (3)Infectious Diseases, VA Greater Los Angeles Healthcare System, Los Angeles, CA, (4)Internal Medicine, University of Utah School of Medicine Division of Epidemiology, Salt Lake City, UT, (5)VA Greater Los Angeles Health Care System, Los Angeles, CA, Los Angeles, CA, (6)University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, UT

Disclosures:

H. Lowenstein, None

M. Bidwell Goetz, None

M. Jones, None

P. Glassman, None

M. Samore, None

C. Graber, None

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