2122. Impact of Pharmacist Intervention on Compliance with a Clostridium difficile Treatment Bundle
Session: Poster Abstract Session: Clostridium difficile: Therapeutics
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • ID week CDI poster FINAL.pdf (2.4 MB)
  • Background: Clostridium difficile infection (CDI) results in increased morbidity and mortality for patients.  Aside from appropriate treatment, other medication interventions have been identified to decrease recurrence rates of CDI.  Care bundles, collections of multiple evidence-based therapies related to a single disease state, have been shown to increase compliance with overall disease management.

    Methods: The objective of this pre-post quasi-experimental study was to assess compliance with a treatment bundle for CDI. From 12/1/15-3/1/16, all inpatients at our institution found to have CDI were evaluated by the clinical pharmacist to ensure bundle compliance. Data was compared to patients who did not receive active pharmacist interventions (12/1/14-3/1/15).  Primary outcomes were adherence to each of the individual components of the bundle (Table 1).  Secondary outcomes included compliance to the bundle as a whole, recurrence within 8 weeks, and readmission for CDI within 8 weeks. 

    Results: A total of 264 patients were analyzed, 125 in the pre-implementation group and 129 in the post.  Results of compliance with individual components are reported in Table 1.   While not statistically significant, trends toward decreased CDI recurrence and readmission within 8 weeks were identified in the post-implementation group (14.1% vs. 10.9%, and 5.2% vs. 3.9%, respectively). 

    Conclusion: Pharmacist intervention significantly increased compliance with a CDI treatment bundle.

    Bundle Component

    Pre-Implementation (%)

    Post-Implementation (%)

    p-value

    Initiation of appropriate treatment

    43/135 (31.9%)

    121/129 (93.8%)

    <0.001

    Narrowing or discontinuing of other antibiotics*

    69/69 (100%)

    75/75 (100%)

    1

    Discontinuing anti-peristaltic medications

    0/1 (0%)

    7/7 (100%)

    0.005

    Discontinuing pro-motility agents

    10/38 (26.3%)

    30/37 (81.1%)

    <0.001

    Discontinuing or de-escalating acid suppressive medications

    51/95 (53.7%)

    62/78 (79.5%)

    <0.001

    Overall bundle compliance

    29/135 (21.5%)

    103/129 (79.8%)

    <0.001

    *Antimicrobial therapy was appropriately assessed by 72 hours after CDI diagnosis.

    Kelsey Powell, PharmD, Angela Huang, PharmD, BCPS-AQ ID and Sara Revolinski, PharmD, BCPS, Froedtert & the Medical College of Wisconsin, Milwaukee, WI

    Disclosures:

    K. Powell, None

    A. Huang, None

    S. Revolinski, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.