198. Pharmacist-Led Antimicrobial Prompting During Interdisciplinary Team Rounds as a Novel Antimicrobial Stewardship Intervention

BACKGROUND: There is a need to develop successful antibiotic stewardship interventions that do not require ID physicians. Our hospital implemented a pharmacist-driven intervention to prompt critical assessment of antibiotic regimens during interdisciplinary team rounds. We evaluated the acceptance of this intervention and the effects on concordance with institutional prescribing guidance. METHODS: This quality improvement initiative took place between November 2016 and June 2017 on a medical ward in an urban, level 1 trauma, public teaching hospital. During interdisciplinary team rounds, if the medicine team’s antimicrobial choice was not concordant with institutional prescribing guidance, the clinical pharmacist made a recommendation. We assessed prescribing for urinary tract infection, skin and soft-tissue infection, and pneumonia pre- and post-intervention. Prescribing was classified as overall guideline-concordant if the antibiotic choices and duration of therapy were consistent with institutional guidance. RESULTS: Thirty cases from each period were evaluated. Recommendations to the medical team were made on 63% (92/146) of days and on 31% (205/664) of patients on antibiotics. The most common recommendation was regarding days of therapy (Figure 1). The recommendations were accepted in 76% (156/205) of cases. (Figure 2). There were improvements in both the inpatient (70% to 83%, P = 0.22) and discharge (64% to 86%, P = 0.35) antibiotic choices and overall guideline concordance (53% to 63%, P = 0.43); however, these were not statistically significant. Concordance with duration of therapy was similar between the periods (76% vs. 77%, P = 0.94) (Figure 3). CONCLUSION: During interdisciplinary rounds, prompting by pharmacists to critically assess antibiotic regimens is a feasible antibiotic stewardship intervention that does not require ID expertise, is generally accepted by physicians, and may increase guideline-concordant antibiotic selection. DISCLOSURES: All authors: No reported disclosures.