167. Medication Use Evaluation for Indication of Antibiotics in a Large Tertiary Medical Center
Session: Poster Abstract Session: Antimicrobial Stewardship: Current State and Future Opportunities
Thursday, October 8, 2015
Room: Poster Hall
Background: Since initiation of computerized physician order entry (CPOE) at Jackson Memorial Hospital, a 1550 bed acute care hospital in Miami, FL, providers are required to select an infection indication for antibiotic use at the time of prescribing. Drop-down menu options included bacteremia, endocarditis, intra-abdominal, meningitis/encephalitis, osteomyelitis, pneumonia, skin and soft tissue, surgical prophylaxis, urinary tract, and other. The purpose of this feature is to aid the verifying pharmacists in evaluating the appropriateness of selection, dose, frequency, and monitoring. A quality assurance evaluation was conducted to assess accurate use of this function.

Methods: A retrospective study was conducted to evaluate whether prescribers chose the indication matching the patient’s condition at order entry. Infection diagnosis was determined by reviewing the electronic medical record (EMR), including cultures. Inclusion criteria were: first-dose, targeted antibiotics (e.g. cefepime, meropenem, piperacillin-tazobactam, and vancomycin), age >18, and admitted to an intensive care unit (ICU). Patients on multiple antibiotics had all first doses included.

Results: 171 orders were collected from the last week of June, July, and August of 2014. Of those, 5 (3%) orders were entered as “bacteremia” without positive blood cultures. For 166 (97%) orders, the chosen indication matched documentation in the EMR. The option “empiric” was selected in 50% of the orders, though patients may have had symptoms of a specific infection.

Conclusion: Our findings suggest that prescribers are documenting an accurate indication when selecting antibiotics. Although “empiric” may have been chosen for patients that exhibited signs of a specific infection, these ICU patients may have had multiple sources, limiting confirmation of diagnosis at the time of prescribing. This function seems to be an accurate tool for pharmacists and antimicrobial stewardship programs evaluating antibiotic selection, dose, and appropriateness.

Eliza Dollard, PharmD1, Laura Aragon, PharmD, BCPS-AQ ID1, Ennie Cano, PharmD, BCPS1, Yara Kuyumjian, PharmD1 and Lilian Abbo, MD2, (1)Pharmacy, Jackson Memorial Hospital, Miami, FL, (2)Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL

Disclosures:

E. Dollard, None

L. Aragon, None

E. Cano, None

Y. Kuyumjian, None

L. Abbo, None

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