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237. Antibiotic Assessment at Discharge-Room for Stewardship Intervention
BACKGROUND: Currently, there is minimal literature detailing the utility or approach to antibiotic stewardship interventions at the transition of care. We sought to evaluate the utility of a stewardship approach where appropriateness of choice and duration of oral antibiotics prescribed at the time...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6253575/ http://dx.doi.org/10.1093/ofid/ofy210.248 |
Sumario: | BACKGROUND: Currently, there is minimal literature detailing the utility or approach to antibiotic stewardship interventions at the transition of care. We sought to evaluate the utility of a stewardship approach where appropriateness of choice and duration of oral antibiotics prescribed at the time of discharge was assessed and, when indicated, recommendations for change provided. METHODS: Between June 2017 and April 2018, an antimicrobial stewardship team, comprising of a pharmacist and infectious disease provider, reviewed the electronic health record (EHR) of patients discharged on oral antibiotics from the Medical Service at the William S Middleton VA Hospital for appropriateness of antibiotic choice and total duration of therapy. Depending on availability of team members, reviews occurred twice weekly and included patients discharged within the previous 4 days. If an antibiotic was felt to be inappropriate, the case was discussed with the prescribing service and/or pharmacist. Recommendations were documented in the form of a note placed in the EHR with an emphasis on education. These interventions were logged and information regarding prescribing team/provider, antibiotic, indication, and type of intervention was collected. Intervention types included (but were not limited to) antibiotic stop, change of antibiotic, dose, or duration, and laboratory recommendations. RESULTS: Stewardship rounds evaluated 463 patients discharged on oral antibiotics from the Medical Service over 177 hospital days. Forty-one interventions were logged in 38 (8.2%) patients, i.e., approximately 1 intervention for every 12 patients discharged on oral antibiotics. The most common intervention type was antibiotic stop (49%), followed by a change in duration (15%). Interventions occurred most commonly in patients treated for COPD (27%), UTI (22%), and pneumonia (15%). Azithromycin (27%), cefpodoxime (12%), and trimethoprim–sulfamethoxazole (12%) were the antibiotics most frequently intervened upon. CONCLUSION: Assessing postdischarge antibiotic therapy with feedback to prescribers is an additional area where Stewardship programs can focus to better optimize usage of antimicrobials. DISCLOSURES: All authors: No reported disclosures. |
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