193. The “July Effect” on Antibiotic Prescribing in the setting of an Antimicrobial Stewardship Program
Session: Poster Abstract Session: Antimicrobial Stewardship: Current State and Future Opportunities
Thursday, October 8, 2015
Room: Poster Hall
Background: In the United States, physicians-in-training begin residences and fellowships on July 1. Due to staff inexperience, this period of time is often associated with increased adverse events, medication errors and increased mortality. Data examining the “July Effect” on antimicrobial prescribing practices are lacking. Our institution’s antimicrobial stewardship program (ASP) uses a hybrid model of pre-authorization and prospective audit and feedback. In July and August, only seasoned infectious diseases attendings, fellows, and pharmacists carry the restricted antimicrobial approval pager. Herein, we examined the “July Effect” on start orders for select antibiotics in the setting of an ASP.

Methods: In this retrospective review (January 2012-December 2013) from a large academic center in New York City, we assessed weekly start orders (combined and separate) of cefepime, imipenem, piperacillin/tazobactam, ertapenem, ceftriaxone, ciprofloxacin and levofloxacin in July and August and compared them to the preceding (weeks 1-26) and subsequent weeks (weeks 36-52) for each calendar year. Changes in antibiotic orders in Jully and August were first assessed without formal testing, followed by segmented regression analysis.  

Results: Unexpectedly, the number of weekly orders of combined antibiotics decreased in July and August compared to previous weeks (-1.9% in 2012 and -2.1% in 2013) while slightly increasing in September-December 2012 (+1.2%) and decreasing in September-December 2013 (-1.1%). The most substantial decrease in July and August was seen for imipenem (-28.5% in 2012; -13.0% in 2013). Segmented regression analysis noted no significant differences in weekly orders of antibiotics (both separate and combined) in July and August when compared to weeks 1-26 and weeks 36-52. A sensitivity analysis using daily orders instead of weekly orders demonstrated no significant differences in antibiotic start orders in July and August. 

Conclusion: Despite inexperienced physicians, a decrease of antibiotic orders, mainly imipenem, was noted in July and August of 2012 and 2013. This demonstrates that a fully staffed and well-supported ASP could potentially affect prescribing practices and counteract the “July Effect”.

Victoria Adams, PharmD, BCPS1, Patricia Saunders-Hao, PharmD, BCPS2, Jashvant Poeran, MD, PhD3, Robert Hiensch, MD4, Madhu Mazumdar, PhD3 and Gopi Patel, MD, MS5, (1)Department of Pharmacy, The Mount Sinai Medical Center, New York, NY, (2)Mount Sinai Hospital, New York, NY, (3)Institute for Healthcare Delivery Science, Division of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, (4)Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, (5)Icahn School of Medicine at Mount Sinai, New York, NY


V. Adams, None

P. Saunders-Hao, None

J. Poeran, None

R. Hiensch, None

M. Mazumdar, None

G. Patel, None

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