Methods: Manual abstraction of medical and pharmacy records in five Wisconsin SNFs was performed prospectively. To be included in this analysis, it was required that the antibiotic event was initiated in the SNF and that a treatment indication for UTI was documented in the record. A standardized checklist was employed to characterize if the antibiotic prescribing for each event was potentially amenable to some form of modification: 1) stopping (if clinical criteria for UTI were not met); 2) shortening (if the initial antibiotic was prescribed for >7 days); and 3) streamlining (if the patient was prescribed a fluoroquinolone and culture results demonstrated susceptibility to narrow spectrum alternatives). Total number of antibiotic events amenable to modification as well as distribution of the different types of modification were enumerated.
Results: A subset (n = 162) of the 1,465 antibiotic events observed in study facilities were initiated within the SNF for a UTI indication. Over half of the UTI prescribing events were amenable to some form of post-prescribing modification. Unnecessary antibiotic use indicating an opportunity for antibiotic discontinuation (50.5%) was the most common post-prescribing modification opportunity identified. 49% of UTI treatment courses were amenable to shortening modifications and 22% of treatment courses were amenable to streamlining modifications.
Conclusion: Even if an unnecessary antibiotic start occurs, our study shows opportunity to improve the quality of antibiotic prescribing in SNFs through post-prescribing review stratgies. Identifying the optimal approach for achieving antibiotic review in this setting requires further study.
L. Taylor, None
D. Nace, None
C. Crnich, None