1431. Enhancing Antimicrobial Stewardship for Pneumonia in the Emergency Department Utilizing a Clinical Decision Support Tool
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions
Saturday, October 10, 2015
Room: Poster Hall
  • Harrington Nicole 20150929 ID poster Enhancing AS for P in the ED.pdf (716.6 kB)
  • Background: Pneumonia (PNA) ideal antibiotic regimen (IAbxR) selection from the Emergency Department (ED) has been directly correlated to improved outcomes, reduced hospital length of stay, costs and secondary infections. The Christiana Care Health System Antimicrobial Stewardship Program (CCHS-ASP) provides recommendations on initial ideal antibiotic regimen (IAbxR). Historically, CCHS ED provider compliance with IAbxR was 55%, with the major gap being overutilization of fluoroquinolones in the absence of a severe beta lactam allergy.  A key barrier to optimal performance of IAbxR selection is the vast potential for selection of multiple antibiotics through our Computerized Provider Order Entry (CPOE) system and provider knowledge gaps. 

    Methods: Using change management principles and tools including stakeholder engagement, data gathering, Plan Do Check Act (PDCA), and rapid cycle testing, we attempted to change practicing culture at CCHS across 3 ED locations.  Our project team successfully addressed organizational behaviors, project barriers and organizational goals, culminating in the development and integration of an electronic ED PNA clinical decision support rule (ED-PNA-CDS) for IAbxR selection.  Post implementation of the ED-PNA-CDS tool, a fifty patient retrospective chart review was conducted to assess the rate of IAbxR compliance with CCHS-ASP guidelines for adult patients admitted to the hospital through the ED with PNA.

    Results: The ED-PNA-CDS launched for all ED providers on February 17, 2015.  To date a total of 699 CDS activations have occurred with 183 activations specific for PNA. The ED-PNA-CDS opt out rate was 8.2% (15/183).  The post project rate of IAbxR compliance was 90% (p = 0.0002).  Fluoroquinolones were only used in patients with a severe beta lactam allergy.

    Conclusion: The development and integration of an electronic ED-PNA-CDS resulted in significant culture change by increasing IAbxR compliance from 55% to 90% for adult ED patients admitted with PNA. Other potential benefits that warrant further investigation include improved clinical patient outcomes, broader institutional antimicrobial stewardship, and improved financial performance for CCHS (ie: reimbursement, length of stay, drug cost).

    Nicole Harrington, PharmD, BCPS1, Paul Sierzenski, MD2, Kim Taylor, Information Technology3 and John Lacolla, Information Technology3, (1)Pharmacy, Christiana Care Health System, Newark, DE, (2)Emergency Medicine, Christiana Care Health System, Newark, DE, (3)Information Technology, Christiana Care Health System, New Castle, DE


    N. Harrington, None

    P. Sierzenski, None

    K. Taylor, None

    J. Lacolla, 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.