1480. Impact of a Guidance Document, Order Set Changes and Physician Education on Antibiotic Prescribing in Acute Exacerbation of COPD
Session: Poster Abstract Session: Respiratory Infections: Miscellaneous
Friday, October 5, 2018
Room: S Poster Hall
  • IDWeek_AECOPD_FINAL 2018 Bergman.pdf (200.7 kB)
  • Background: Current guidelines provide vague recommendations regarding antibiotic choice, duration and patients most likely to benefit from antibiotics during an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). We sought to improve antibiotic prescribing through multidisciplinary creation of a clinical guidance document, order set with imbedded clinical decision support (CDS), and provider education on the management of AECOPD.

    Methods: A quasi-experimental study was conducted in adult patients (age >18 years) admitted to Nebraska Medicine for suspected AECOPD before and after clinical decision support was introduced. Patients in the pre-implementation period (10 weeks, 4/15-6/30/16, N=44) and a similar post-implementation period (10 weeks, 4/12-6/29/17, N=51) were included if COPD was the primary diagnosis code or the COPD exacerbation order set was used at admission. Exclusion criteria included AECOPD admission within the previous 30 days and transfer from an outside hospital. Outcome measures included: percentage of patients receiving antibiotics, median length of therapy, order set usage, antibiotic choices, length of stay (LOS) and oral steroid use.

    Results: Post-implementation, the percentage of patients prescribed antibiotics decreased (86.4% vs 60.8%, p=0.006) as did antibiotics ordered from the order set (29.5% vs 13.7%). Median length of therapy decreased from 5 days to 1 day pre- versus post-implementation, respectively . Fluoroquinolone use decreased from 43.2% to 25.5% while azithromycin use remained consistent (18.2% vs 17.6%). Oral steroid use increased post-implementation (27.3% vs 41.2%) and average duration of steroid use decreased (11.1 vs 8.7 days). Average LOS was 3.7 days in both groups and in-hospital mortality was low (2% vs 0%).

    Conclusion: Implementation of an AECOPD guidance document, order set with CDS, and education resulted in significant decreases in antibiotic usage, particularly for fluoroquinolones. Other areas of care also improved using a syndromic stewardship strategy. Our data supports the utilization of this strategy to promote evidence-based antibiotic management in AECOPD.

    Jayme Anderson, PharmD, BCPS, Nebraska Medicine, Omaha, NE, Spencer Evans, PharmD candidate, University of Nebraska Medical Center College of Pharmacy, Omaha, NE, Scott Bergman, PharmD, FIDSA, FCCP, BCPS, Department of Pharmaceutical Care, Nebraska Medicine, Omaha, NE and Trevor Van Schooneveld, MD, FACP, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE


    J. Anderson, None

    S. Evans, None

    S. Bergman, None

    T. Van Schooneveld, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.