1417. Antimicrobial Time Out: Novel Approach to Expand Antimicrobial Stewardship in a Large, Tertiary Medical Center
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • AbxTimeoutposter FINAL.pdf (99.3 kB)
  • Background: A new initiative was developed at our medical center in which antimicrobial (AM) stewardship was incorporated into Progression of Care Rounds (POCR), a daily interdisciplinary discussion led by a physician champion along with representatives from pharmacy, nursing, case management, social work, and clinical nutrition to identify opportunities to improve care management and facilitate discharge planning.  

    Methods: During the pilot intervention period from November 11, 2014 to March 15, 2015, one infectious disease (ID) pharmacist or physician prescreened patients on a medical and a surgical ward to identify AM-related opportunities (AROs). ARO was defined as an eligible evidence-based intervention and categorized as: “escalation” (initiate or broaden AMs), “de-escalation” (discontinue or narrow AMs), or “other.” Other interventions included IV to PO conversion, dose adjustment, therapeutic drug monitoring, additional lab/culture or ID consult. The ID pharmacist or physician then attended POCR to discuss the AROs after which they contacted the prescribing physicians to make recommendations. Interventions were documented utilizing Theradoc® and categorized as described above.  For each successful de-escalation intervention, antimicrobial days saved was calculated based on national evidence-based guidelines.

    Results: During the intervention period, approximately 450 patients were screened of which 182 AROs were identified. Seventy percent (127/182) of the AROs were classified as “de-escalation”, 10% (19/182) as “escalation”, and 20% (36/182) as “other.”  The overall acceptance rate for the interventions was 84% (153/182), with a total of 482 calculated AM days saved. Common reasons for prescriber non-acceptance included non-response, or acceptable and non-acceptable declination. Prescriber non-acceptance was mainly from internal medicine and infectious disease physicians.

    Conclusion: Incorporation of AM stewardship into existing interdisciplinary rounds can facilitate reducing the misuse, overuse, and suboptimal use of AMs.  Future directions include housewide implementation of this program and integration of AM stewardship into the medical staff performance improvement process.

    Niyati Vakil, PharmD, BCPS1, Angela Hirai-Yang, PharmD1, Paula Gaut, MD2, Hai Tran, PharmD1, William Stanford, MD3, Harry Sax, MD4, Jonathan Grein, MD5, Rita Shane, PharmD, FASHP, FSCHP1, Hanina Stettin, MSOD6, Tyler Woolsey, MHA6, Andrea Censullo, MD7, Andrew Ma, MD7 and Rekha Murthy, MD, FIDSA, FSHEA8, (1)Pharmacy Services, Cedars-Sinai Medical Center, Los Angeles, CA, (2)Infectious Disease, Cedars-Sinai Medical Center, Los Angeles, CA, (3)Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, (4)Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, (5)Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, CA, (6)Quality Improvement, Cedars-Sinai Medical Center, Los Angeles, CA, (7)Infectious Disease, Cedars-Sinai/UCLA Multicampus Program in Infectious Diseases, Los Angeles, CA, (8)Hospital Epidemiology, Cedars-Sinai Health System, Los Angeles, CA

    Disclosures:

    N. Vakil, None

    A. Hirai-Yang, None

    P. Gaut, None

    H. Tran, None

    W. Stanford, None

    H. Sax, None

    J. Grein, None

    R. Shane, None

    H. Stettin, None

    T. Woolsey, None

    A. Censullo, None

    A. Ma, None

    R. Murthy, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.