Characteristics of Prospective Audit and Feedback in a Pediatric Cardiovascular Intensive Care Unit

BACKGROUND: Prospective audit and feedback (PAF) in the pediatric cardiovascular intensive care unit (CVICU) has not been elaborated. A formal program was implemented in our institution’s pediatric CVICU on 12/07/15. The purpose of this study was to describe characteristics of PAF recommendations in a pediatric CVICU after implementation with a comparison of antimicrobial utilization before and after. METHODS: Antimicrobial audits for patients admitted to the Lucile Packard Children’s Hospital Stanford CVICU between December 7, 2015 and November 30, 2016 were reviewed. Audits were performed by the Antimicrobial Stewardship Program (ASP) Pharmacist and reviewed with the ASP Medical Director, before being communicated to the CVICU Pharmacist. The CVICU Pharmacist communicated recommendations to the medical team, and adherence was assessed within 48 hours. The days of therapy (DOT) per 1,000 patient-days from June 1, 2015 to November 30, 2016 were collected to evaluate the impact of PAF on antimicrobial utilization. RESULTS: During the study period, there were 475 antimicrobial audits and 156 recommendations; the majority of which were accepted (77%). The most common recommendation was to stop the antimicrobial (53%) and vancomycin and piperacillin-tazobactam were the antimicrobials with the greatest number of recommendations (37% and 21%, respectively). Half of the recommendations were for antimicrobials prescribed for sepsis, either rule-out or culture negative. The average DOT/1000 patient-days for aggregate antimicrobial use in the CVICU decreased from 1,172 in the 6 months preceding PAF implementation to 995 over the subsequent 12 months, representing a 15% reduction in utilization. Broad spectrum Gram-negative antibiotic utilization decreased by 8.7% (288 vs. 263 DOT/1000 patient-days) while broad spectrum Gram-positive antibiotic utilization fell by 27% (240 vs. 174 DOT/1000 patient-days) over the same time period. CONCLUSION: One-third of antimicrobials audited in the pediatric CVICU resulted in a PAF recommendation. Recommendations were typically made on broad spectrum antibiotics and for patients without microbiologically-confirmed infection. Implementation of a formal PAF program in the pediatric CVICU resulted in reduced antimicrobial utilization. DISCLOSURES: All authors: No reported disclosures.