222. The Impact of Education and Prospective Audit and Feedback on Reducing Ciprofloxacin Utilization at a Small Community Academic Hospital

BACKGROUND: Fluoroquinolones have been associated with severe and even disabling side effects. Increasing resistance has rendered these agents less favorable for empiric therapy. In light of these concerns and in response to a period of above-average use at a small community-based academic hospital, we implemented a quality improvement initiative to reduce utilization of ciprofloxacin. METHODS: The multidisciplinary Antibiotic Stewardship Program (ASP) at Barnes-Jewish West County Hospital, a 77-bed facility, developed and disseminated guidelines for ciprofloxacin use to all physicians via an electronic newsletter and in-person meetings with provider groups identified as having high ciprofloxacin utilization rates beginning in June 2017. Included in the guidelines were recommendations for more effective, safer alternatives to ciprofloxacin for common infection types. In December 2017, the ASP pharmacist initiated prospective audit and feedback (PAF) for all ciprofloxacin orders. Ciprofloxacin utilization was measured monthly in days of therapy (DOT)/1,000 patient-days utilizing medication administration data. Patient days were determined according to National Healthcare Safety Network (NHSN) conventions. RESULTS: During the preintervention period (June 2015 to June 2017), ciprofloxacin utilization rates averaged 73.3 DOT/1,000 patient-days, but in May 2017, use increased to 138.3. Following provider education, average utilization decreased to 56.9 DOT/1,000 patient-days from September 2017 to November 2017. With the addition of PAF, average ciprofloxacin utilization decreased to 43.6 DOT/1,000 patient-days from December 2017 to March 2018, a 41% reduction compared with the preintervention period. Utilization of other fluoroquinolones did not increase. CONCLUSION: Education was a useful tool in reducing inappropriate ciprofloxacin use; however, a combination of prospective audit and feedback with education achieved the greatest impact on curbing ciprofloxacin use. This multimodal approach was effective and sustainable at a small hospital with limited antibiotic stewardship resources. DISCLOSURES: J. G. Newland, Merck: Grant Investigator, Research grant.