194. Mandatory Antimicrobial Duration at the Time of Computerized Physician Order Entry: What’s the Harm?

BACKGROUND: Mandatory documentation of antimicrobial duration in the electronic medical record is recommended by national organizations as a core element for antimicrobial stewardship programs (ASP). Published literature evaluating the safety of mandatory antimicrobial order durations is limited. Children’s Mercy Kansas City (CM), a free-standing pediatric hospital, implemented mandatory stop dates for all systemic antimicrobial orders on February 14, 2017. Antimicrobials, with an ordered stop date within 24 hours, are generated on a daily discontinuation (DC) report. Clinical pharmacists are responsible for daily review of the DC report and intervening when ordered stop dates do not align with treatment plans. ASP serves as a “double-check” by also reviewing the DC report and only intervening when orders would unintentionally discontinue. This study sought to evaluate the safety of mandatory stop dates in a pediatric institution. METHODS: A retrospective evaluation of mandatory stop dates was completed at CM from February 14, 2017 to March 31, 2018. Antimicrobial orders were identified from the DC reports. ASP recorded interventions performed to avoid unintentional antimicrobial discontinuation, and actual unintentional discontinuations were identified through ASP and internal event reports. RESULTS: A total of 4,905 antimicrobial orders were reviewed on the DC report with a median of 12 orders per day [IQR 9–15]. ASP intervention occurred on 350 orders with a median monthly intervention rate of 7.1% [IQR 5.4–7.8]. Since implementation, the monthly ASP intervention rate has declined (Figure 1). ASP intervention rates were significantly higher on weekends than weekdays (10.8% vs. 6.8%, P < 0.001). ASP inventions occurred on a variety of indications ranging from prophylaxis to meningitis (Figure 2). Four orders had unintentional discontinuations resulting in missed doses of antibiotics but no negative clinical outcomes. CONCLUSION: Mandatory antimicrobial durations at the point of order entry can be safely implemented with clinical pharmacy involvement and a “double-check” ASP process. Our findings suggest unintentional discontinuation of antimicrobial agents may occur without a structured double-check procedure. [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures.