The Christiana Care Antimicrobial Stewardship Program developed a pilot initiative for tracking and monitoring antibiotic utilization across the health system. This initiative aligns with the Joint Commission’s elements of performance, which calls for tracking and reporting of antibiotic prescribing, as well as the Centers for Medicare and Medicaid Services recommendations for documentation of antibiotic indication, dose, and duration with each order. A customized indication list in the order entry field was created for cefepime, ceftriaxone, levofloxacin, and ciprofloxacin orders.
A retrospective chart review of antibiotic indications was completed. A maximum of 50 orders per each antibiotic from December 31st, 2017 to January 6, 2018 were randomly selected to be evaluated. The primary endpoint of our study was the percent of cases in which the indication was selected according to the true indication per chart review. Secondary endpoints included the percent of cases in which “other indication” was selected where an available indication was appropriate, percent of cases in which the appropriate dose and frequency were prescribed, and percent of cases in which the duration of therapy was appropriate for urinary tract infections (UTIs).
A total of 540 orders were profiled between December 31st, 2017 and January 6, 2018, of which 182 were reviewed. In regards to accuracy of selected indication, 94% of cefepime, 88% of ceftriaxone, 78% of ciprofloxacin, and 89% of levofloxacin orders were considered appropriate. Dosing was most appropriate among ciprofloxacin orders (100%), followed by ceftriaxone (96%), cefepime (94%), and levofloxacin (74%). Frequency was most appropriate among ceftriaxone orders (98%), followed by ciprofloxacin (87%), levofloxacin (78%), and cefepime (74%). Duration of therapy was appropriate in greater than 90% of UTI orders.
The pilot initiative for tracking and monitoring of antibiotic indications has allowed for enhanced transparency between providers regarding antimicrobial use. Further evaluation may provide greater understanding of antibiotic utilization and aid in identifying opportunities for improvements.
J. Gardner, None
J. Dougherty, None
D. Walsh, None
E. Dzuriak, None
M. Drees, None
S. Eppes, None
S. Kharidi, None
L. Cheung, None
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