34. Development of a Pharmacy Resident Implemented Prospective Audit and Feedback Antimicrobial Stewardship Intervention
Session: Posters in the Park: Posters in the Park
Wednesday, October 3, 2018: 5:30 PM
Room: N Hall D Opening Reception and Posters in the Park Area
Posters
  • IDWeek2018_ResidentPAF_Poster_Final34.pdf (565.5 kB)
  • Background: Antimicrobial stewardship programs (ASPs) implement activities to improve antimicrobial use and patient outcomes. Prospective audit and feedback (PAF) has demonstrated effectiveness over sole preauthorization (PA) interventions. PAF implementation utilizing non-infectious diseases (ID) trained pharmacists including residents is not well characterized.

    Methods: We aimed to evaluate use of a post-graduate year one pharmacy resident to implement PAF at a 602-bed tertiary academic medical center. Monday through Friday mornings, a report was generated within the electronic health record (EHR) to identify patients on select antibiotics for ≥48 hours. The resident reviewed patients and made recommendations to the medical teams or clinical pharmacy specialists. Complicated patients were discussed with an infectious disease (ID) clinical pharmacy specialist.

    Results: 227 patients were reviewed with the report identifying a mean (SD) 24 (±6.7) patients per day. Subsequently, ~20% of patients necessitated review with an ID clinical pharmacy specialist. Of all patients reviewed, 179 (79.2%) were intervened upon. Almost half (46.3%) of interventions were in patients with pneumonia or intra-abdominal infections. Ceftriaxone 49 (27.3%), intravenous vancomycin 35 (19.6%) and piperacillin-tazobactam 23 (12.8%) were intervened upon the most. Recommendations were primarily made to Medicine 74 (41.3%), Surgery 43 (24%), and Critical Care 26 (14.5%) services. Primary recommendations were duration of therapy or de-escalation for Medicine [36 (48.6%), 24 (32.4%)], Surgery, [24 (55.8%), 9 (20.9)], and Critical Care [7 (26.9%), 10 (38.4%)], respectively. ID was consulted on 35 (19.6%) patients with interventions. For select antimicrobials, days of therapy per 1000 patient days decreased from 733.1 to 669.4 from March 2017 to March 2018.

    Conclusion: Non-ID trained clinical pharmacists or residents may perform PAF activities effectively. This informs potential PAF targets and may allow ASPs to reach more patients while optimizing escalation of complicated cases to an ID specialist.

    Heather Savage, PharmD1, Jefferson Bohan, PharmD, BCPS2, Kyana Stewart, PharmD, BCPS3, S. Travis King, PharmD, BCPS3 and Jonathan Hand, MD4, (1)Pharmacy, Ochsner Clinic Foundation, New Orleans, LA, (2)Pharmacy, Ochsner Health System, New Orleans, LA, (3)Pharmacy, Ochsner Medical Center, New Orleans, LA, (4)Infectious Diseases, Ochsner Clinic Foundation, New Orleans, LA

    Disclosures:

    H. Savage, None

    J. Bohan, None

    K. Stewart, None

    S. T. King, Melinta Therapeutics: Speaker's Bureau , Speaker honorarium .

    J. Hand, None

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