182. Successes of a system-directed and multi-faceted inpatient antimicrobial stewardship program in a large, integrated delivery organization
Session: Poster Abstract Session: Antimicrobial Stewardship: Interventions Leveraging the Electronic Health Record
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • IDWeek2018 System ASP.pdf (248.4 kB)
  • Background:

    In 2015, Baylor Scott & White Health (BSWH) implemented a system-wide antimicrobial stewardship program (ASP) across 22 acute care facilities. The ASP committee, led by an Infectious Diseases (ID) Physician and ID Pharmacist, includes membership of health system leadership, facility-specific ID physician and clinical pharmacy leaders, informatics, infection control, and microbiology. The committee’s purpose was to facilitate local implementation of antimicrobial stewardship interventions recommended by the Centers for Disease Control and Prevention and to improve antimicrobial use at BSWH.

    Methods:

    The ASP created and approved antibiotic use guidelines (carbapenems, vancomycin, daptomycin, fluoroquinolones), policies, and set performance goals related to antibiotic use, which were then implemented locally at each facility. Beginning July 2016, all 22 acute care facilities went live with a clinical decision support (CDS) tool, a mobile device platform for physician access to ASP guidelines, and a requirement for antibiotic review at 48-72 hours. The CDS software also provided tracking of utilization data as days of therapy (DOT) standardized to 1000 patient days at risk (DAR) at the local facility and health system levels. The ASP committee tracked and reported metrics on the usage of total and targeted antibacterials, with comparisons in usage made between fiscal years (FY) 2017 and 2018. Means of total antibacterial usage and targeted antibiotics were compared between July to March of each FY using t-tests.

    Results:

    Mean total antibacterial usage for the BSWH system was 649.6 versus 622.6 DOT/1000 DAR for FY17 and FY18, respectively (difference-Δ: 27.0; CI 95%: 7.9-46.1; p=0.008). Mean targeted antibacterial usage (in DOT/1000 DAR, FY17 vs FY18) was 100.2 vs 92.8 for vancomycin (Δ: 7.4; CI 95%: 5.0-9.9; p<0.001), 30.4 vs 20.7 for carbapenems (Δ: 9.7; CI 95%: 7.2-12.3; p<0.001), 80.1 vs 60.1 for fluoroquinolones (Δ: 20.0; CI 95%: 17.1-22.9; p<0.001), and 4.6 vs 4.4 for daptomycin (Δ: 0.2; CI 95%: -0.5-1.0; p=0.454).

    Conclusion:

    BSWH has made significant progress in reducing targeted and overall total antibacterial usage through implementation of an enterprise level antimicrobial stewardship program using a multi-faceted approach.

    Peter Colley, PharmD, BCPS-AAHIVQ, Pharmacy, Baylor University Medical Center, Dallas, TX, Rema Thyagarajan, PharmD, BCPS, Pharmacy, Baylor Scott & White Health, Dallas, TX, Hoa Nguyen, MD, MS, PhD, Baylor University Medical Center, Dallas, TX, Andrew Masica, MD, MSCI, Baylor Scott & White Health, Dallas, TX and Donald Storey, MD, Baylor Scott & White Health, Irving, TX

    Disclosures:

    P. Colley, None

    R. Thyagarajan, None

    H. Nguyen, None

    A. Masica, None

    D. Storey, 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.