1246. Impact of Leveraging Clinical Decision Support Tools to Implement a Tiered Antimicrobial Stewardship Workflow at a Rural Academic Medical Center

BACKGROUND: The Infectious Diseases Society of America and The Joint Commission recommend Antimicrobial Stewardship Programs (ASPs) incorporate preauthorization and/or prospective audit and feedback (PAF) as mechanisms for stewardship interventions. However, each institution must customize their ASP workflow. The ASP at West Virginia University Hospitals (WVUH), a rural, comprehensive academic medical center, was recently revamped by leveraging clinical decision support (CDS) tools via a tiered workflow in efforts to prioritize stewardship interventions for preauthorization and PAF. METHODS: In March 2021 ASP pharmacists created a tiered workflow incorporating CDS tools from Theradoc® and Epic®. Review of patients identified on CDS alerts (Table 1), preauthorization, and PAF were conducted Monday through Friday 8:00 am to 5:00 pm by ASP pharmacist(s). Tiered workflow effectiveness was measured by internal and external benchmarking: antimicrobial days of therapy (DOT)/1000 days present, antimicrobial spend, and Standardized Antimicrobial Administration Ratio (SAAR). Interventions were documented within the electronic medical record and tracked via a Quality Assurance and Performance Improvement (QAPI) format. Post implementation data from March 2021 to March 2023 was analyzed and compared to baseline 2019 data. [Figure: see text] CRE: Carbapenem-resistant Enterobacterales; ESBL: Extended Spectrum Beta-Lactamase; HIV: Human Immunodeficiency Virus RESULTS: The following outcomes were observed within the post implementation timeframe. Monthly average DOT/1000 days present decreased ≥ 20% for the following antimicrobials: vancomycin (27%), ceftaroline (53%), cefepime (20%), ertapenem (59%), aztreonam (68%), tigecycline (23%), fosfomycin (80%), micafungin (27%), ceftazidime-avibactam (40%). Monthly average total antimicrobial SAAR decreased by 11% from 1.216 to 1.074. Additionally, monthly average antimicrobial spend/patient day decreased by 36% from $26.47 to $16.95. QAPI data demonstrated a 74% intervention acceptance rate including correction of 344 drug-bug matches. CONCLUSION: Implementation of a tiered ASP workflow effectively identified patients for interventions, decreased antimicrobial utilization, and demonstrated antimicrobial cost containment. Acceptance of stewardship interventions was favorable. This tiered approach may serve as a model for other ASPs. DISCLOSURES: All Authors: No reported disclosures