190. Promise and pitfalls: analyzing the accuracy and perceptions of documenting antibiotic indication during order entry
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions Leveraging the Electronic Health Record
Thursday, October 4, 2018
Room: S Poster Hall
  • ID week poster ind aud final.pdf (513.2 kB)
  • Background: The CDC and The Joint Commission recommend that prescribers document an indication (IND) when ordering antibiotics (ABX). However, to assist ABX stewardship efforts, the IND needs to be accurate. Previous data with ABX order forms showed that the IND provided by prescribers is often erroneous. This study sought to assess the accuracy of IND documentation as well as prescriber perceptions of the indication requirement at our institution.

    Methods: Patients (pts) who received ≥1 dose of ceftriaxone, ciprofloxacin, ertapenem, oxacillin, piperacillin/tazobactam, or vancomycin from 5/1/17 to 6/30/17 were identified. The electronic medical records of 30 randomly selected pts who received each study ABX were retrospectively reviewed. Pts receiving multiple ABX were evaluated only once. The primary endpoint was IND accuracy defined as agreement of IND entered during order entry and the IND documented in progress notes at time of order entry. Secondary endpoints included correlation of entered IND and final diagnosis (DX) for empiric ABX and IND accuracy according to prescribing service and specific IND. A brief survey was emailed to prescribers to assess the burden and perceptions of requiring an IND during order entry.

    Results: 4524 pts received ≥1 dose of a study ABX. Of the 180 pts selected for evaluation, 89.4% of INDs were accurate. 51.7% of ABX were classified as empiric, 41.1% as definitive, and 7.2% as prophylactic. ABX entered as prophylaxis were more likely to be inaccurate than empiric or definitive ABX (46%, 94%, 92%, respectively, p<0.05). For empiric ABX, 78.5% of INDs documented at order entry matched the final DX. IND accuracy varied among services (81.8 - 94.7%, p=NS). 254 of 863 (29%) prescribers responded to the survey. Respondents felt that documenting the IND took ≤10 (33%) or 11-20 seconds (33%). They considered it a “minor nuisance” (46%) or “occasionally burdensome” (27%). Most (55%) felt it had no impact on their consideration of ABX appropriateness.

    Conclusion: With the exception of prophylaxis, the accuracy of ABX IND documented during order entry was sufficiently reliable to assist stewardship efforts. Although IND documentation is perceived as only a minor burden, prescribers attributed minimal beneficial effect on ABX prescribing.

    James Beardsley, PharmD1,2, Mark Vestal, PharmD3, Norbert Rosario, PharmD3, Kalyn Meosky, PharmD3, James Johnson, PharmD1,2, John Williamson, PharmD1,2, Vera Luther, MD2 and Christopher Ohl, MD, FIDSA2, (1)Department of Pharmacy, Wake Forest Baptist Health, Winston-Salem, NC, (2)Department of Internal Medicine, Section on Infectious Diseases, Wake Forest School of Medicine, Winston-Salem, NC, (3)School of Pharmacy, Wingate University, Wingate, NC


    J. Beardsley, None

    M. Vestal, None

    N. Rosario, None

    K. Meosky, None

    J. Johnson, None

    J. Williamson, None

    V. Luther, None

    C. Ohl, 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.