260. Effect of Antibiotic Indications on Clinician Documentation and Pharmacy Workflow in Hospitalized Children
Session: Poster Abstract Session: Pediatric Antimicrobial and Diagnostic Stewardship
Thursday, October 4, 2018
Room: S Poster Hall
Posters
  • ID Week Poster 2018-T. Scardina.pdf (374.1 kB)
  • Background: Documentation of antibiotic indication at the time of order entry is mandated by the Centers for Disease Control and Prevention. We evaluated the effect of this mandate on the accuracy of clinician documentation and pharmacy work flow in hospitalized children.

    Methods: Documentation of indication at our institution was required beginning 3/30/17. All patients ≤ 18 years old that received ≥1 dose of intravenous (IV) vancomycin (VAN) or IV/intramuscular ceftriaxone (CTX) during a one month pre-intervention period and 3 post-intervention study periods (at 0, 3, and 6 months following implementation) were included. Patients were only included once per study period. Data included timing of antibiotic administration, indication for use, infection at body site requiring potential dose modification, dose modification, and agreement between order and progress note.

    Results: Median age of patients was 4.2 years. Most common indications for VAN (total: 789) were sepsis syndrome (26%, N= 204), febrile neutropenia (12%, N=95) and suspected catheter-related bloodstream infection (10%, N=77) and for CTX (total: 1071) were sepsis syndrome (12%, N=127), perforated appendicitis (12%, N=125), and urinary tract infection (10%, N=107).

    Table: Changes in workflow and documentation pre/post-intervention

    Baseline

    Period 2

    Period 3

    Period 4

    p

    CTX

    N=202

    N=173

    N=142

    N=142

    Median time to administration (minutes)

    70

    53

    47

    60

    P<0.01

    Order-progress note agreement

    --

    46% (79/173)

    33% (47/142)

    44% (62/142)

    Infection with potential dose modification

    31% (62/202)

    49% (84/173)

    45% (64/142)

    51% (72/142)

    P<0.01

    Dose modified

    6% (12/202)

    17% (29/173)

    15% (21/142)

    15% (21/142)

    P=0.01

    VAN

    N=107

    N=111

    N=113

    N=109

    Median time to administration (minutes)

    73

    83

    78

    84

    p=0.49

    Order-progress note agreement

    --

    45% (50/111)

    50% (56/113)

    43% (47/109)

    Infection with potential dose modification

    42% (45/107)

    50% (56/111)

    50% (56/113)

    58% (63/109)

    p=0.14

    Dose modified

    28% (30/107)

    27% (30/111)

    17% (19/113)

    38% (41/109)

    p=.01

    Conclusion: Agreement between orders and progress notes was less than 50% during the post-intervention period for both antibiotics. Median time to administration decreased for CTX, but not VAN. Antibiotic modifications were more common in the post-intervention periods.

    Tonya Scardina, PharmD, Pharmacy, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, Larry Kociolek, MD, MSCI, Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL and Sameer Patel, MD, MPH, Pediatric Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL

    Disclosures:

    T. Scardina, None

    L. Kociolek, Alere/Techlab: Investigator , Research support .

    S. Patel, Merck: Grant Investigator , Grant recipient and Research grant .

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