Background: Mandatory documentation of antimicrobial duration in the electronic medical record is recommended by national organizations as a core element for antimicrobial stewardship programs (ASP). Published literature evaluating the safety of mandatory antimicrobial order durations is limited. Childrens Mercy Kansas City (CM), a free-standing pediatric hospital, implemented mandatory stop dates for all systemic antimicrobial orders on 2/14/2017. Antimicrobials, with an ordered stop date within 24 hours, are generated on a daily discontinuation (DC) report. Clinical pharmacists are responsible for daily review of the DC report and intervening when ordered stop dates do not align with treatment plans. ASP serves as a double-check by also reviewing the DC report and only intervening when orders would unintentionally discontinue. This study sought to evaluate the safety of mandatory stop dates in a pediatric institution.
Methods: A retrospective evaluation of mandatory stop dates was completed at CM from 2/14/2017 3/31/2018. Antimicrobial orders were identified from the DC reports. ASP recorded interventions performed to avoid unintentional antimicrobial discontinuation, and actual unintentional discontinuations were identified through ASP and internal event reports.
Results: A total of 4905 antimicrobial orders were reviewed on the DC report with a median of 12 orders per day [IQR 915]. ASP intervention occurred on 350 orders with a median monthly intervention rate of 7.1% [IQR 5.47.8]. Since implementation, the monthly ASP intervention rate has declined (Figure 1). ASP intervention rates were significantly higher on weekends than weekdays (10.8% vs 6.8%, p < 0.001). ASP inventions occurred on a variety of indications ranging from prophylaxis to meningitis (Figure 2). Four orders had unintentional discontinuations resulting in missed doses of antibiotics but no negative clinical outcomes.
Conclusion: Mandatory antimicrobial durations at point of order entry can be safely implemented with clinical pharmacy involvement and a double-check ASP process. Our findings suggest unintentional discontinuation of antimicrobial agents may occur without a structured double-check procedure.
G. Weddle, None
T. Frank, None
R. Ogden, None
B. O'Neal, None
J. Goldman, None
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